What are the recommended first-line topical treatments for a child diagnosed with impetigo?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Recommended first-line topical treatments for a child diagnosed with impetigo:

  • Hydrogen peroxide 1% cream is recommended as the first-line topical treatment for localized non-bullous impetigo in children.
  • If hydrogen peroxide 1% cream is unsuitable (for example, if impetigo is around the eyes) or ineffective, a short course of a topical antibiotic should be offered.
  • The first-choice topical antibiotic recommended is fusidic acid 2% cream, based on its effectiveness and lower risk of adverse effects.
  • If fusidic acid resistance is suspected or confirmed, topical mupirocin 2% is recommended as an alternative.

These recommendations apply to children who are not systemically unwell or at high risk of complications.

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