Impetigo is a highly contagious, bacterial infection of the skin, most commonly seen in children. It is typically diagnosed clinically and the aim of treatment is to clear the eruption and prevent the spread of infection to others. Topical treatment is usually adequate although oral antibiotics can be used for extensive infection.
Impetigo is usually diagnosed clinically. Swabs may be required for recurrent infections, treatment failure with oral antibiotics or where there is a community outbreak.
For correspondence regarding impetigo in asymptomatic carriers in rest homes, see "Correspondence: management of impetigo", BPJ 21 (June, 2009).
The aim of treatment is to clear the eruption and prevent the spread of the infection to others.
Oral antibiotics are suitable for more extensive impetigo or when systemic symptoms are present because of the difficulty of applying topical antibiotics to large areas. Topical antibiotics are less suitable for recurrent infection, because the risk of inducing bacterial resistance is greater with topical antibiotics than with oral antibiotics.
Seven days of topical antibiotic treatment appears to be effective.9 It is not recommended to exceed ten days treatment as this may make contact sensitisation more likely and may encourage bacterial resistance.
For more detailed information on the treatment of impetigo with antibiotics, including alternatives, see the latest edition of our handbook, "Antibiotics: Choices for common infections", bpacnz.
Children may find the taste of flucloxacillin syrup very unpleasant. Advise parents to offer a glass of fruit juice to their child directly after taking a dose.
If patients wish to remove crusted areas, soak a clean cloth in a mixture of half a cup of white vinegar in a litre of tepid water. Apply this compress to affected areas for about ten minutes several times a day and then gently wipe away crust.4 Topical antibiotic can then be applied. Note: bullous impetigo should not be lanced.
Cover the affected areas and wash hands after touching patches of impetigo or applying antibiotic cream or ointment.
Use separate towels, flannels, clothing and bathwater until the infection has cleared. Disinfect linen and clothing by hot wash, hot dry or ironing.
Use hand sanitisers and/or careful washing with household soap and water, several times daily.
Images contributed by NZ DermNet, the website of the New Zealand Dermatological Society.
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