NICE published an antimicrobial prescribing strategy for adults, young people and children aged 72 hours and over with impetigo. The guideline aims to optimise antibiotic use and reduce resistance.

Hydrogen peroxide 1 per cent cream is the treatment of choice for localised non-bullous impetigo in people who are not systemically unwell or at high risk of complications. If hydrogen peroxide 1 per cent cream is unsuitable, a short course of a topical antibiotic could be offered. The guidelines offer suggestions about choosing the antimicrobial. 

A short course of a topical or oral antibiotic is also appropriate for widespread non-bullous impetigo in people who are not systemically unwell or at high risk of complications. 

The guidelines recommend a short course of an oral antibiotic for everyone with bullous impetigo and for those with non-bullous impetigo who are systemically unwell or at high risk of complications. Combinations of topical and oral antibiotics are not advised. 

Healthcare professionals should advise people with impetigo to seek medical help if symptoms worsen rapidly or significantly at any time, or have not improved after completing a course of treatment, the guidelines add.