| Choice | Drug | Dosage |
|---|---|---|
| 1st choice | Fusidic acid 2% cream | Dose: |
| Or | ||
| Metronidazole 0.75% cream/gel | Dose: Apply thinly twice daily as per product literature |
Prescribing Notes
- To avoid the development of resistance, topical mupirocin or fusidic acid should only be used for localised infections and not be used for longer than 7 days. Local microbiology advice should be sought before using in hospital.
- For acute impetigo topical antibiotics should be reserved for very localised lesions. Small areas of the skin may be treated by short-term topical application of fusidic acid three to four times a day.
- If impetigo is extensive or long-standing an oral antibacterial such as flucloxacillin (or erythromycin in penicillin allergic) should be used.
- Hydrogen peroxide cream (Crystacide®) may be used as an alternative agent to topical antibiotics.
- Silver sulfadiazine cream is used for infected burns and ulcers.
- Topical antibacterials should be avoided in leg ulcers unless used for short courses for defined infections, treatment of bacterial colonization is generally inappropriate.
- Metronidazole gel is helpful for secondary infections of fungating tumours.
Caution
- Mupirocin (Bactroban®) ointment should not be used in conditions where absorption of large quantities of polyethylene glycol is possible, especially if there is evidence of moderate or severe renal impairment.