Pharmacy First Pathway Editor

Impetigo - Non-Bullous Impetigo (Pharmacy First)

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>=10YESNONONo allergyAllergyNot pregnantPregnant>=1YES0NOyes
Outcome

Localised non-bullous impetigo. Offer hydrogen peroxide 1% cream for 5 days (subject to inclusion/exclusion criteria in protocol) plus self care. Apply a thin layer to affected area(s) up to 3 times a day for 5 days.

outcome_hydrogen_peroxide outcome info
Outcome

Offer clarithromycin for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care. For penicillin-allergic patients who are NOT pregnant.

outcome_clarithromycin outcome info
Question

Is hydrogen peroxide unsuitable or ineffective?

h2o2_suitability decision select
Referral

Patient is not eligible for this pathway. Refer to GP or appropriate service.

outcome_not_eligible referral info
Outcome

Widespread non-bullous impetigo. Offer flucloxacillin (if no allergy) for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care. Dosing by age: • 1 to <2 years: 125mg four times daily • 2–9 years: 250mg four times daily • 10–17 years and adults: 500mg four times daily Take 1 hour before or 2 hours after food.

outcome_flucloxacillin outcome info
Outcome

Offer fusidic acid cream for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care. Apply 3 times a day for 5 days.

outcome_fusidic_acid outcome info
Referral

Urgent: call 999 or signpost patient to A&E immediately. Consider calculating NEWS2 Score ahead of signposting patient to A&E or calling 999 in a life-threatening emergency.

outcome_emergency referral info
Outcome

Impetigo less likely. Consider alternative diagnosis and proceed appropriately.

outcome_not_impetigo outcome info
Question

Consider the risk of deterioration or serious illness. Select ANY that apply.

emergency_screen decision select_multiple
Question

Does the patient follow typical progression of impetigo clinical features? Confirm likely presentation of impetigo through visual examination in a consultation room: • 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

clinical_presentation decision select
Info

For patients with visual examination indicating impetigo

intro_guidance select
Outcome

Offer erythromycin for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care. For pregnant patients (aged 16+) with penicillin allergy.

outcome_erythromycin outcome info
Question

Is the patient pregnant?

pregnancy_check decision select
Question

Does the patient have ≤ 3 lesions/clusters present?

extent_assessment decision select
Question

Reported penicillin allergy (via National Care Record or Patient/Carer)?

allergy_check decision select
Question

Is the patient eligible for the Impetigo pathway? Select ANY that apply.

eligibility checklist select_multiple

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