If you or your child has a lot of impetigo, or if it’s making you feel generally unwell, your doctor may suggest antibiotic tablets instead of, or as well as, antibiotic creams or ointments. Your doctor is also likely to prescribe antibiotic tablets if antibiotic creams haven’t worked, or if there’s some reason why you can’t use creams. You need a prescription from your doctor for these treatments.
You’re likely to be prescribed flucloxacillin for seven days. If you can’t take flucloxacillin because you’re allergic to penicillin-type antibiotics, you may be prescribed erythromycin. There haven’t been any studies looking specifically at flucloxacillin compared with a dummy (placebo) treatment. But other similar antibiotics have been tested, and work well.  
Antibiotics tablets work about as well as antibiotic creams or ointments. Some types of antibiotic creams and ointments may work a little better than some antibiotic tablets, but there isn’t much difference. 
Some doctors prescribe creams and tablets together. We don’t know whether having both antibiotic tablets and creams together works better than having them separately.
Antibiotic tablets are more likely to have side effects than antibiotic creams.
Flucloxacillin may cause stomach upsets. Very rarely, it can cause liver disease. Doctors are advised to be careful about using it for people who have liver problems. Some people are allergic to flucloxacillin. Side effects of erythromycin also include stomach upsets.
In a few people, the impetigo doesn’t clear up with antibiotic tablets. If that’s the case, you may need tests to find out what type of bacteria is causing the problem. Occasionally, impetigo is caused by a type called methicillin-resistant Staphylococcus aureus ( MRSA). This may need treating with a different type of antibiotic cream, called mupirocin (brand name Bactroban). It works about as well as fusidic acid, but fewer bacteria are resistant to it. However, because mupirocin is used in hospitals to fight MRSA, it’s only used for impetigo that is caused by MRSA. That’s to try to stop bacteria becoming resistant to mupirocin. 
A placebo is a 'pretend' or dummy treatment that contains no active substances. A placebo is often given to half the people taking part in medical research trials, for comparison with the 'real' treatment. It is made to look and taste identical to the drug treatment being tested, so that people in the studies do not know if they are getting the placebo or the 'real' treatment. Researchers often talk about the 'placebo effect'. This is where patients feel better after having a placebo treatment because they expect to feel better. Tests may indicate that they actually are better. In the same way, people can also get side effects after having a placebo treatment. Drug treatments can also have a 'placebo effect'. This is why, to get a true picture of how well a drug works, it is important to compare it against a placebo treatment.
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