Impetigo - Stage 1 – Registration and Initial Information Date Patient Name and DOB GP Address including Postcode Practice Please note: The service is only available to patients who are registered with a GP in one of the four South Staffs CCGs (SES and Seisdon, East Staffs, Stafford and Surrounds, Cannock Chase). Consent: All patients who access this service must give consent for information to be shared with their GP. If patient under the age of 16 years - must attend with a parent / guardian who must give consent. Inclusion Criteria Impetigo - a painless infection of the skin May be itchy Vesicles that weep and dry to form yellow-brown crusts May present with small inflammatory halo around vesicles Pharmacist to give advice on Impetigo Care should be taken to avoid contagious spread of impetigo. It is generally suggested that advice to families should recommend: Careful hand washing after touching a patch of impetigo Avoidance of sharing towels, flannels and so on until the infection has gone Children should stay away from nursery or school until there is no further crusting Exclusion Criteria Age less than 1 year Patients who are systemically ill must be referred to GP Lesions that are painful Large amount of inflammation around lesions, refer – cellulitis?? Bullous impetigo Patient treated for impetigo in the last month Treatment Options under PGD Where treatment under PGD is indicated: Which of the following apply? Non-localised lesions Lesions over 3cm Systemic Antibiotic Required: 1st line is penicillin Patient can take penicillin? Supply flucloxacillin Penicillin allergy/sensitivity Supply Clarithromycin Small localised areas Lesions small (less than 3cm) Topical Antibiotic Required.

Supply fusidic acid Consultation outcome Flucloxacillin - Go to Clarithromycin - Go to Fusidic Acid - Go to stage 2 Flucloxacillin stage 2 Clarithromycin stage 2 Fusidic Acid Referral to GP as Referral to GP as client Treatment not supplied and exclusions apply unable to take any of the no referral made (briefly antibiotics available via this state why) PGD

Impetigo - Stage 2 – Flucloxacillin Exclusion Criteria Allergy / hypersensitivity to Penicillins Small localised areas can be treated with topical fusidic acid Renal or Hepatic impairment Refused consent Flucloxacillin Dose – see PGD Children aged 1-2 yrs: syrup 62.5mg QDS for 5 days Children aged 2 - 5 yrs: 125mg four times a day for 5 days Children aged 6 - 10 yrs: 250mg QDS for 5 days 11 yrs and above: 500mg QDS for 7 days

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Impetigo - Stage 2 – Clarithromycin Exclusion Criteria Allergy to clarithromycin / other macrolides Small localised areas - treat with topical fusidic acid Renal or liver disease Pregnancy Breastfeeding Refused consent Patient on interacting drug Check BNF/SPC Clarithromycin Treatment period for all patients is 7 days Supply 125mg/5ml suspension for all children up to 10 years, Supply suitably licensed 250mg/5ml susp for 10 years+, Consider tablets for age 12 years + Age 1-2 yrs: 62.5mg twice daily. Age 3-5 yrs: 125mg twice daily. Age 7-9 yrs: 187.5mg twice daily. Age 10 yrs and older: 250mg twice daily. Adults: 250mg twice daily

Counselling for Stage 2 - Flucloxacillin and Clarithromycin Patient information leaflet given Advise possible side Effects Take regularly Store syrup in refrigerator and shaken before each dose Finish the course Check current meds / any OTCs for potential interactions Serious adverse reaction If the patient suffers a serious, significant adverse reaction the pharmacist should notify the patient's GP, record the information on the PMR, complete and submit a yellow card.

Impetigo - Stage 2 – Fusidic acid cream or Sodium fusidate ointment Exclusion Criteria Allergy to Fusidic acid / sodium fusidate or prep component Potential compliance issues Underlying skin condition on same area of body as impetigo Refused consent Counselling for Stage 2 – Fusidic acid cream or sodium fusidate ointment Patient information leaflet given Advise possible side Effects Application - wash hands before use If possible remove scabs - bathe with warm water before use Do not scratch or pick spots Apply cream three times daily on school days and four times daily on other days Do not share cream with anyone else Extended use may increase risk of contact sensitisation and the development of antibiotic resistance Use cream for 7 days then discard tube responsibly Medication Supply Information Drug, presentation and quantity given: Batch Number…………………………………………………………….Expiry Date…………………………………………………. Where a supply was made, the following must also be completed: PMR entry completed Tablets labelled "Supplied Patient consent collected? under PGD" Levy collected? Exemption form signed? Please note: Exemption forms should be retained in the pharmacy in case requested by Area Team.

For consultations carried out without a live PharmOutcomes connection the patient must sign the declaration. Otherwise consent is recorded electronically.

Client’s Signature: Date:

Pharmacists Name: GPhC number: Signature: Date:

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