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Exclude: bullous impetigo, recurrent impetigo (defined as 2 or more episodes in the same year), pregnant individuals under 16 years
Exclude: bullous impetigo, recurrent impetigo (defined as 2 or more episodes in the same year), pregnant individuals u...
Fusidic acid cream can be offered 2nd line if:
  • Hydrogen peroxide unsuitable, for example if impetigo is around eyes
  • Hydrogen peroxide treatment has been ineffective and impetigo still remains localised
Fusidic acid cream can be offered 2nd li...
Does the patient have ≥4 lesions/clusters present?
Does the patient have ≥4 lesions/clusters present?
Patient is immunosuppressed and infection is widespread Severe c...
Confirm likely presentation of impetigo
through visual examination in a consultation room
Confirm likely presentation of impetigo...
NHSE PATHWAYS
NHSE PATHWAYS
Consider the risk of deterioration, red flags or serious illness
Consider the risk of deterioration, red flags or serious illness
Consider calculating NEWS2 Score ahead of signposting patient to A&E or calling 999 in a life threatening emergency
Consider calculating NEWS2 Score ahea...
YES
YES
NO
NO
NICE CKS
NICE CKS
NHSE PGDs
NHSE PGDs
Impetigo
Impetigo
NHS
NHS
Gateway Point
Gateway Point
Does the patient follow typical progression of impetigo clinical features:
Does the patient follow typical progression of impetigo clinical features:
Impetigo (Non-bullous impetigo, for adults and children aged 1 year and over)
Impetigo Context: UK Pharmacy First Scheme Impetigo Assessment (Non-...View PGD in right panelView PGD in right panel
Digital PGD
 Digital PGD
Gateway Point
Gateway Point
  • The initial lesion is a very thin-walled vesicle on an erythematous base, which ruptures easily and is seldom observed
  • The exudate dries to form golden yellow or yellow-brown crusts, which gradually thickens
  • Lesions can develop anywhere on the body but are most common on exposed skin on the face (the peri-oral and peri-nasal areas), limbs and flexures (such as the axillae)
  • Satellite lesions may develop following autoinoculation
  • Usually asymptomatic but may be mildly itchy
  • Refer to NHS.UK website for images of impetigo
The initial lesion is a very thin-walled vesicle on an erythematous base, which ruptures easily and is seldom observed The exudat...
Does the patient have ≤3 lesions/clusters present?
Does the patient have ≤3 lesions/clusters present?
Consider alternative diagnosis
and proceed appropriately
Consider alternative diagnosis...
YES
YES
YES
YES
YES
YES
NO
NO
Impetigo less likely
Impetigo less likely
Impetigo more likely
Impetigo more likely
or if unsuitable or ineffective
or if unsuitable or ineffective
Offer hydrogen peroxide 1% cream for 5 days (subject to inclusion/exclusion criteria in protocol) plus self care
Offer hydrogen peroxide 1% cream for 5 d...
Localised non-bullous impetigo
Localised non-bullous impetigo
Offer flucloxacillin (if no allergy) for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care
Offer flucloxacillin (if no allergy) for...
Widespread non-bullous impetigo
Widespread non-bullous impetigo
Reported penicillin allergy
(via National Care Record or Patient/Carer)
Reported penicillin allergy...
Offer fusidic acid cream for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care
Offer fusidic acid cream for 5 days (...
If pregnant
 If pregnant
Offer clarithromycin for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care
Offer clarithromycin for 5 days (subj...
Offer erythromycin for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care
Offer erythromycin for 5 days (subjec...
FOR ALL PATIENTS:
  • Offer advice on importance of good hygiene to reduce spread of impetigo
  • Offer advice on how to take their medicines to encourage adherence
  • If symptoms worsen rapidly or significantly at any time, OR do not improve after completion of treatment course
  • Share self-care and safety-netting advice using British Association of Dermatologist Impetigo leaflet
FOR ALL PATIENTS:...

Content sourced and adapted from NHS Pharmacy First – Clinical Pathways and Patient Group Directions (PGDs) on the NHS England website, licensed under the Open Government Licence v3.0.

Content sourced and adapted from NHS Pharmacy First – Clinical Pathways and Patient Group Directions (PGDs) on the NHS England website, licensed under the Open Government Licence v3.0.
  • General practice
  • Other provider as appropriate
General practice Other...Onward referralText is not SVG - cannot display