International Comparisons of Impetigo Guidelines

A recent systematic review of guidelines of the management of impetigo was published in the Family Practice Journal.

Impetigo is a common skin infection that is usually treated with antibiotics, with this is in mind, study authors aimed to determine the management implications for the disease worldwide.1

The goal of this review was to compare international impetigo guidelines. The guidelines included were those made by national authorities, available to primary care physicians, and published since 2008. After a comprehensive search, data was taken from eligible studies and performed independently, according to the article. The analysis of antiseptic and antibiotic treatment, methicillin-resistant Staphylococcus aureus treatment, and conservative management and preventative measures were detailed.

In all, 51 guidelines from 42 different countries were included in the analysis with all guidelines recommending systemic antibiotics, but 78% of these were only for widespread lesions or failure of topical antibiotic treatment.

The first-line systemic antibiotic treatment was restricted to narrow-spectrum options in 21 (41%) guidelines while in 7 (14%) of them only broad-spectrum were recommended. Also, 34 (67%) guidelines included recommendations for topical antibiotic use and 24 (39%) guidelines did not mention antiseptic treatment for impetigo. There were not always indications for different treatment options.

Many guidelines did not include recommendations for non-antibiotic treatments like antiseptics, preventative measures, and conservative management. Clear definitions of disease severity and indications for treatment would help increase the ability of clinicians to adhere to recommendations, the article concluded.


1. Hall L, Gorges H, van Driel M, et al. International comparison of guidelines for management of impetigo: a systematic review. Family Practice. Published June 29, 2021. Accessed December 7, 2021.