Management of impetigo

Treatment of impetigo supports skin healing and prevents the development of more serious complications (eg sepsis, bone and joint infections, poststreptococcal complications including acute rheumatic fever)The Australian Healthy Skin Consortium, 2023.

Management of impetigo involves all of the following:

• anti-infective therapy
  • Empirical therapy for patients with limited nonbullous impetigo
  • Empirical therapy for patients with extensive, recurrent or bullous impetigo
• examining for and treating coexisting dermatoses (eg dermatitis, scabies, head lice or tinea)The Australian Healthy Skin Consortium, 2023
• general measures to reduce the spread of impetigo to other areas of the body and to other people; see Patient information: Advice for reducing the spread of impetigo for a printable patient handoutNational Institute for Clinical Excellence (NICE), 2020.

Acute rheumatic fever is more likely to occur following recurrent streptococcal infections, including impetigo. Treat impetigo in all patients at high risk of acute rheumatic fever with empirical therapy for patients with extensive, recurrent or bullous impetigo. If a patient develops impetigo while receiving benzathine benzylpenicillin for prevention of recurrent acute rheumatic fever, seek advice from a specialist with expertise in rheumatic fever. Ask the patient about adherence to prophylaxis, and treat with empirical antibiotic therapy for impetigo if it has been more than 7 days since the last dose of benzathine benzylpenicillin.