Impetigo
Bacterial Infections of the Skin
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ICD 10 code: L01.0-1
DESCRIPTION
- A common contagious skin infection caused by streptococci or staphylococci
- Predominantly occurs in children
- Often secondary to scabies, insect bite, eczema or tinea capitis
- Clinical features:
- Pus containing blisters
- Commonly starts on the face or buttocks
- Erosion of blisters with honey coloured crusts
- Spreads to neck, hands, arms and legs
- Post-streptococcal glomerulonephritis is a potential complication
GENERAL MEASURES
- Counsel on good personal and household hygiene to avoid spread of the infection and to reduce carriage of organisms
- Trim finger nails
- Wash and soak sores in soapy water to soften and remove crusts
- Continue with general measures until the sores are completely healed
- Check urine for blood if the sores have been present for more than a week
MEDICINE TREATMENT
- Povidone iodine 5%, cream or 10% ointment, apply 8 hourly
If extensive or systemic signs of infection (fever, unwell, fatigued), ADD
Children ≤ 7 years of age
- Cefalexin, oral, 25 mg/kg/dose 12 hourly for 5 days. See: dosing table
OR
- Flucloxacillin, oral, 12–25 mg/kg/dose 6 hourly for 5 days. See: dosing table
Children > 7 years of age and adults
- Cefalexin, oral, 500 mg 6 hourly for 5 days
OR
- Flucloxacillin, oral, 500 mg 6 hourly for 5 days
LoE:IVb6
For severe penicillin allergy:
ICD 10 code: Z88.0
Children
- Macrolide, e.g.:
- Azithromycin, oral, 10 mg/kg/dose daily for 3 days. See: dosing table
Adults
- Macrolide, e.g.:
- Azithromycin, oral, 500 mg daily for 3 days
Note:
If impetigo has improved, but has not completely cured, give a 2nd 5-day course of antibiotics.
REFERRAL
- No improvement after second course of antibiotics
- Presence of blood on urine test strip for longer than 5–7 days
- Clinical features of glomerulonephritis. See: Nephritic syndrome
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_07 November 2024
Chapter 5: Skin Conditions_5.4.2 Impetigo