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Impetigo - Non-Bullous Impetigo (Pharmacy First)

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0>=1[sepsis]0>=1>=1>=10 or any months old1 or above0000>=1>=1YESNOYESNOAllergyNot pregnantPregnant0No allergyyesNOalways0no>=10>=1>=1>=1>=10>=10
Question

Check fusidic acid cream eligibility, Select ALL that apply. If none apply, select "none apply".

node_1773803173030 select_multiple
Referral

Urgent: Sepsis suspected. Call 999 immediately. Refer urgently to A&E via ambulance.

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Outcome

Impetigo less likely. Consider alternative diagnosis and proceed appropriately.

outcome_not_impetigo outcome info
Referral

Patient falls under hydrogen peroxide PGD exclusion criteria. Onward referral — General practice or other provider as appropriate.

referral_h202_failed select
Referral

Patient falls under fusidic acid cream PGD exclusion criteria. Onward referral — General practice or other provider as appropriate.

referral_fusidic_failed select
Question

Check clarithromycin eligibility, Select ALL that apply. If none apply, select "none apply".

node_1773799441108 select_multiple
Question

Check erythromycin eligibility, Select ALL that apply. If none apply, select "none apply".

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Question

Does the patient have ≤ 3 lesions/clusters present?

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Question

Concurrent medication for flucloxacillin. Select ALL that apply. If none apply, select "none apply".

node_1773795405480_copy select_multiple
Question

Check hydrogen peroxide eligibility, Select ALL that apply. If none apply, select "none apply".

h2o2_eligibility select_multiple
Referral

Patient falls under erythromycin PGD exclusion criteria. Onward referral — General practice or other provider as appropriate.

referral_erythromycin _failed select
Referral

Patient falls under flucloxacillin PGD exclusion criteria. Onward referral — General practice or other provider as appropriate.

referral_flucloxacillin_failed select
Referral

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

outcome_not_eligible referral 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

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
Question

Is hydrogen peroxide unsuitable or ineffective?

h2o2_suitability decision select
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
Question

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

allergy_check decision select
Question

Is the patient pregnant?

pregnancy_check decision select
Outcome

Widespread non-bullous impetigo. Offer flucloxacillin for 5 days 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 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
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
Info

For patients with visual examination indicating impetigo. Press next to confirm.

intro_guidance select
Referral

Patient falls under clarithromycin PGD exclusion criteria. Onward referral — General practice or other provider as appropriate.

referral_clarithromycin_failed select
Question

Enter patient age.

patient_age number
Question

Select ALL that apply. If none apply, select "none apply".

eligibility checklist select_multiple
Referral

Patient not eligible for pathway (under 1 years old). Please refer to GP or appropriate service.

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Referral

Urgent: Refer to a prescriber for further same-day assessment.

node_1773794842595 select
Question

Select ALL that apply. If none apply, select "none apply".

node_1773794435901 select_multiple
Question

Select ALL that apply. If none apply, select "none apply".

emergency_screen decision select_multiple
Referral

Patient falls under clarithromycin PGD exclusion criteria. Onward referral — General practice or other provider as appropriate.

referral_clarithromycin_failed_copy_1773812939921_0 select
Question

Concurrent medication for clarithromycin. Select ALL that apply. If none apply, select "none apply".

clarith_concurrent_ select_multiple
Referral

Patient falls under flucloxacillin PGD exclusion criteria. Onward referral — General practice or other provider as appropriate.

referral_flucloxacillin_concurrent select
Referral

Patient falls under erythromycin PGD exclusion criteria. Onward referral — General practice or other provider as appropriate.

referral_erythromycin _failed_copy_1773812608141_0 select
Question

Check flucloxacillin eligibility, Select ALL that apply. If none apply, select "none apply".

node_1773795405480 select_multiple
Question

Concurrent medication for erythromycin. Select ALL that apply. If none apply, select "none apply".

erythromycin_concurrent select_multiple
Question

Does the patient follow typical progression of impetigo clinical features? Confirm through visual examination: • 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 be 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

clinical_presentation decision select

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