Who to refer and red flags

The Patient Group Directions (PGDs) for impetigo list specific inclusion and exclusion criteria. Most cases of suspected impetigo will not be systemically unwell but parents/guardians may be concerned about their child’s appearance.

A few patients may have symptoms suggesting more severe illness (e.g. painful, hot, swollen skin, and spreading redness) or who are at risk of severe illness (e.g. immunosuppressed individuals).

The PGDs for insect bites and stings also list specific criteria for referral. Most of the people who attend the pharmacy with suspected infected insect bites or stings will not be systemically unwell but may be concerned because of local pain and inflammation.

A few patients may have symptoms suggesting more severe illness (e.g. signs of a systemic hypersensitivity reaction) or who are at risk of severe illness (e.g. immunosuppressed individuals). It is important to recognise this and ensure they get urgent care.