NICE: Hydrogen peroxide for impetigo

 Adapted from :NICE issues antimicrobial prescribing guidance for impetigo

curated by Pavankumar Kamat UK Medical News 28 Feb 2020

National Institute for Health and Care Excellence (NICE) recently published antimicrobial prescribing guidance which describes the antimicrobial strategy for adults, young people and children aged ≥72 hours with impetigo.

According to the new NICE guidance, GPs should prescribe topical hydrogen peroxide 1% instead of topical antibiotics for patients with localised non-bullous impetigo.
The guidance states that hydrogen peroxide 1% cream is as effective as topical antibiotics in patients with localised, non-bullous impetigo, provided they are not systemically unwell or at risk for complications.

If hydrogen peroxide 1% cream is not suitable or if symptoms have worsened or not improved, a short course of a topical antibiotic may be considered.
A topical or oral antibiotic is recommended for patients with widespread non-bullous impetigo, provided they are not systemically unwell or at risk for complications. Oral antibiotic treatment is recommended for patients who have bullous impetigo or if they are systemically unwell or at high risk for complications.
NICE does not recommend a combination of topical and oral antibiotic. There is no evidence that the combination works more effectively than a topical treatment alone.
The primary choice of topical antibiotic is fusidic acid 2%, and the secondary option is mupirocin 2%. The drug of choice for first-line oral antibiotic therapy is flucloxacillin, with clarithromycin and erythromycin (for pregnant women) as secondary choices.

References
Impetigo: antimicrobial prescribing: NICE guideline [NG153]. National Institute for Health and Care Excellence. 2020 February.

My comment: Impetigo is a common skin infection caused by staphloccus which tends to colonise up people’s noses. It spreads rapidly in the nursery and primary school environments. Previously it was treated with oral penicillin. Children are advised to stay off school to reduce spread. Any effective topical, non antibiotic treatment, is welcome as this will help reduce antibiotic resistance.