Impetigo - Antibiotic Prescribing

Comments from Expert Advisory Group

  • Impetigo in children is highly contagious
  • Do not offer combination topical and oral antibiotics
  • As resistance is increasing reserve topical antibiotics for very localised lesions (≤ 3 lesions).  Prior to application of topical antibiotics soak off crusts with petroleum jelly (Vaseline®) and gently remove with a warm, damp facecloth to increase absorption
  • HPSC update on group A Streptococcus
  • 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
Non-bullous vs Bullous Impetigo
Image: Non-Bullous Impetigo Image: Bullous Impetigo


Perioral honey-coloured crusts in impetigo

Image Source: Dermnet


Widespread bullous impetigo over the back

Image Source: Dermnet


Drug Children’s Dose Adult Dose Duration Notes
1st choice option
Flucloxacillin See flucloxacillin dosing table for children 500mg every 6 hours 5-7 days

Avoid in penicillin allergy

To optimise absorption, take on an empty stomach (either 1 hour before food or 2 hours after food).

2nd choice options


See cefalexin dosing table for children 500mg every 12 hours 5-7 days Cephalosporins should not be used in severe penicillin allergy.


See clarithromycin dosing table for children

250mg every 12 hours

(can be increased if necessary in severe infection to 500mg every 12 hours)
5-7 days Macrolides should be used with caution in pregnancy. Clarithromycin suitable only in 2nd and 3rd trimester in pregnancy.
1st choice option in pregnant, penicillin allergic patients


  300mg every 6 hours 5-7 days Caution: risk of C. difficile.

Topical Treatment for  Non-Bullous Impetigo (Reserve for very localised lesions – ≤3 lesions)

Fusidic Acid

Topically to affected areas every 8 hours 5-7 days  

Advice for the patient/carer

  • Contact school/child care facilities to determine how long a child should stay away (usual guidance is to stay home until lesions have crusted over, or until 24 hours after patients have started treatment, however some establishments may have their own guidance)
  • Keep sores, blisters and crusty patches clean and dry
  • Encourage patient and household contacts to wash hands regularly
  • Wash flannels, sheets and towels at a high temperature
  • Wash or wipe down toys with detergent and warm water if children have impetigo

Patient Information

We recommend patients use the following links to get further information about managing impetigo:

Safe Prescribing (visit the safe prescribing page)

Reviewed November 2022

antibiotics banner