Impetigo - Antibiotic Prescribing

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC). See guidance on dosing in children for quick reference dosage/weight guide. Refer to drug interactions table for detailed drug interactions for all antimicrobials. Note extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.

Note additional warnings for clarithromycin and fluoroquinolones

• Check our Safe Prescribing page for more information
• Check our Tips on prescribing in penicillin allergy for more information

Panton-Valentine Leukocidin (PVL) is a toxin produced by 2% of Staphylococcus aureus and is associated with persistent recurrent pustules and carbuncles or cellulitis. Send swabs for culture in these clinical scenarios. On rare occasions it causes more severe invasive infections, even in otherwise fit people. Risk factors include: nursing homes, contact sports, sharing equipment, poor hygiene and eczema.

Comments from Expert Advisory Committee

• Systematic review indicates topical and oral treatment produces similar results.^A+
• As resistance is increasing reserve topical antibiotics for very localised lesions.^{C or D} Reserve Mupirocin for MRSA.
• Impetigo in children is highly contagious.
• Treat with oral flucloxacillin as per body weight.
• See children's weight table.

Treatment

See guidance on dosing in children for quick reference dosage/weight guide.