No mistake has been made, it is just that practice has altered since the last time someone in Gemma’s family was prescribed a product for impetigo. Guidance published in February 2020 followed a significant piece of work looking at impetigo and its treatments, particularly in light of growing concerns regarding antibiotic resistance. Evidence points towards the topical antiseptic hydrogen peroxide 1% cream being as effective as topical antibiotics such as fusidic acid for the localised non-bullous form of impetigo – the more common and contagious form of the condition – and with minimal risk of adverse effects. It was therefore a no-brainer to recommend that prescribers switch to this as first-line treatment. 

Hydrogen peroxide 1% cream should be applied two or three times a day for five days. It should be accompanied by hygiene measures such as washing the affected area with soap and water; washing hands regularly, particularly after touching the impetigo; avoiding scratching affected areas; avoiding sharing towels, face cloths and other personal care products; and thoroughly cleaning potentially contaminated toys and play equipment. These should help to reduce its spread to other areas of the body and other people. If symptoms don’t improve, or worsen rapidly or significantly, medical advice is needed.

Topical fusidic acid does still have a place in therapy, but is reserved for cases where hydrogen peroxide hasn’t worked or is unsuitable, for example, if there are lesions around the eyes.