General considerations

It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing in breastfeeding when looking at the available information and making treatment decisions.

This article covers the first-line topical treatments for the management of localised, non-bullous impetigo.  See our advice on penicillins and macrolide antibiotics which may be required in more complex or widespread infection.

Recommendations

Topical fusidic acid, hydrogen peroxide or mupirocin can all be used during breastfeeding.

There is limited or no published evidence of use of these topical medicines during breastfeeding. However, there is limited systemic absorption and therefore negligible levels are expected in breast milk.

Clinical considerations

Care should be taken to avoid direct contact between the infant and impetigo lesion(s) and treated area.

If lesions are on the breast or close to the nipple, it may not be possible to feed from that breast, although this would need thorough assessment. Infant feeding support should also be sought in order to effectively maintain milk supply.

Hands should be washed after applying topical preparations and before touching the infant.

Specific recommendations

Patient Information

The NHS website provides advice for patients on the use of specific medicines in breastfeeding.

Contact us

Get in touch with the UK Drugs In Lactation Advisory Service (UKDILAS), our specialist breastfeeding medicines advice service if you need support in the following situations:

• you need further advice
• the medicine in question is not included here
• the infant is unwell or premature
• multiple medicines are being taken

About our recommendations

Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.

If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data is now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.

Bibliography

Full referencing is available on request.