Other considerations

Medicines safety

As with all antibiotics, extended or recurrent use of topical fusidic acid or mupirocin may increase the risk of developing antimicrobial resistance. See the BNF for more information.

About 10% of the general population claim to have a penicillin allergy; this is often because of a skin rash that occurred while taking a course of penicillin as a child. Fewer than 10% of people who think they are allergic to penicillin are truly allergic. See the NICE guideline on drug allergy: diagnosis and management for more information.

People with a history of immediate hypersensitivity to penicillins may also react to cephalosporins and other beta‑lactam antibiotics (BNF, November 2019).

Macrolides should be used with caution in people with a predisposition to QT interval prolongation (BNF, November 2019).

See the summaries of product characteristics for information on contraindications, cautions, drug interactions and adverse effects of individual medicines.

Medicines adherence

Medicines adherence may be a problem for some people taking antibiotics that need frequent dosing or longer treatment duration (see the NICE guideline on medicines adherence).

Resource implications

  • Recommended antibiotics are available as generic formulations. See the Drug Tariff for costs.

  • The incremental cost of hydrogen peroxide 1% cream is estimated to be around £3.50 more per person, when compared with current treatment options for people with localised non-bullous impetigo who are not systemically unwell or at risk of complications. We expect the population that will be eligible for this treatment will not be greater than around 125,000 people per year, with the biggest incidence occurring in children.

See the evidence review for more information.