Prescribers should use hydrogen peroxide cream rather than antibiotics in patients with localised non-bullous impetigo as part of drives to cut antibiotic resistance, new guidelines from NICE state.

The joint recommendations with Public Health England said hydrogen peroxide 1% cream is just as effective at treating non‑bullous impetigo as a topical antibiotic at treating non‑bullous impetigo.

Non-bullous impetigo is the more common form of the highly infectious skin infection, usually starting with a rash of small, pus-filled blisters, compared to bullous impetigo, which presents with sores and intact blisters.

NICE said while it usually clears up within two to three weeks without treatment, it is usually treated with an antibiotic to prevent the spread of infection and speed up recovery. 

Under the new guidance, prescribers should consider hydrogen peroxide 1% cream as an alternative to antibiotics for children and adults with localised, non-bullous impetigo.

In cases where hydrogen peroxide is not suitable, a short course of a topical antibiotic such as fusidic acid should be given instead, the joint guidelines say. 

Oral antibiotics should be the first choice in cases where the patient may develop complications or is systemically unwell, the advice states. 

And for patients with widespread non-bullous impetigo, a topical or oral antibiotic can be used taking into account the potential for antibiotic resistance. 

But combination treatment with both oral and topical antibiotics should not be used to treat the common condition, say NICE and PHE. 

NICE said the guidance aimed optimise antibiotic use and reduce antibiotic resistance. 

The recommendations also point out that good hygiene measures should be advised to prevent spread of impetigo to other areas of the body and to other people.