Skin infection guidance and antimicrobial stewardship
Evidence-based decisions in impetigo, infected eczema, cellulitis and scabies.
Updated: 2026-09-13
Written for clinicians and medical students
This section is a teaching reference for doctors, residents and medical students. It is not patient guidance and not a substitute for clinical examination, and it must not be used for self treatment.
Stewardship decisions
- For localised non-bullous impetigo in a systemically well patient, consider local antiseptic or topical antibiotic according to current local guidance; oral treatment is reserved for widespread, bullous or systemically significant disease [1].
- An eczema flare with weeping or crusting is not always bacterial infection. In patients who are not systemically unwell, antibiotics add limited benefit to appropriate eczema treatment [2].
- Cellulitis is usually unilateral, warm, tender and expanding. Bilateral red legs more often indicate venous or inflammatory disease and should trigger diagnostic reconsideration [3].
- Treat scabies cases and close contacts together, repeat treatment when the product requires it, and address bedding and clothing according to public-health guidance [4].
Local context
Culture purulent, recurrent, treatment-resistant or outbreak-associated disease when results will alter care. Local resistance patterns, medicine availability and infection-control policies take priority over a foreign guideline.