Hydrogen peroxide

• Cream 1% (£8.07 x 25g)

Indications and dose

• Localised non-bullous impetigo
  • Adults and children: Apply 2-3 times a day for 5–7 days

Potassium permanganate

• Tablets for cutaneous solution 400mg (£28.62 = 30 tablets)
  • For external use only: One tablet to be dissolved in 4 litres of water to provide a 0.01% (1 in 10,000) solution
  • An alternative treatment option should also be recommended if it is to be used in the patient’s home (see note 3)

Notes

1. Potassium permanganate concentrate is considered less suitable for prescribing due to the risk of harm from inadvertent oral administration.
2. Potassium permanganate concentrate should always be prescribed on an individual patient basis. It should only be prescribed by, or on the recommendation of, a specialist secondary care / community service team member with experience in its use.
3. Where the specialist is making a recommendation for the prescribing of potassium permanganate concentrate for use in the patient’s home, they should also recommend an alternative treatment option to enable the prescriber to select the most appropriate treatment for the individual patient’s circumstances. The prescriber MUST undertake a risk assessment at the time of each prescription for potassium permanganate (follow note 5 below).
4. In the secondary care setting:
   1. Potassium permanganate concentrate should be prescribed in line with the trust policy for minimising the risk of inadvertent oral administration of potassium permanganate.
   2. If a patient needs to receive potassium permanganate in their own home, the prescriber is required to conduct a risk assessment (follow note 5 below). Secondary care is responsible for prescribing or supply on discharge from hospital.
5. Prescribing for use in the patient’s home:
   1. If a patient needs to receive potassium permanganate treatment in their own home, then a risk assessment MUST be undertaken to ensure the patient can store and use potassium permanganate concentrate safely (NPSA 05 April 2022). This should be done at the time of discharge from secondary care and at the time of each prescription in the community setting (see also notes 2 and 3 and note 8 for BAD guidance). The risk assessment should ensure the following:
      1. The patient is able to self-manage, or the carer can undertake, potassium permanganate soaks.
      2. The patient/carer can, and will, store potassium permanganate concentrate safely in the patient’s home, out of reach of children or vulnerable adults, and separately to other oral medication.
      3. The patient has the cognitive ability and visual acuity to self-manage and prepare the dilution, with no risk of inadvertent swallowing of potassium permanganate concentrate by patient, a family member, or a regular visitor to the patient’s home.
      4. The patient can dispose of the diluted solution safely and return any excess potassium permanganate concentrate to their local pharmacy.
   2. The outcome of the risk assessment should be documented clearly in the patient’s clinical records and/or the discharge summary.
   3. If deemed unsafe to store: the patient MUST NOT be given a supply of potassium permanganate concentrate.
   4. Prescribe as an acute prescription. Repeat prescribing is not permitted. The initiating prescriber should define duration of treatment and date of review.
   5. Prescribe as ‘Potassium permanganate 400 mg tablets for cutaneous solution’ with clear instructions that the concentrated form must be diluted in water as directed to obtain a 0.01% (1 in 10,000) or more dilute solution, to use the diluted solution as a soak, and that it is ‘HARMFUL IF SWALLOWED’.
   6. Prescribe as 30 tablets to ensure original pack dispensing.
6. Patient information
   1. The patient and the carer should be given appropriate information. The British Association of Dermatologists has developed a patient information leaflet ‘How to use potassium permanganate soaks’.
   2. Do not use a ceramic basin or bath, keep out of contact with fabric as it stains.
7. National Patient Safety Alert: Inadvertent oral administration of potassium permanganate (05 April 2022). NHS England has issued this alert in light of the continued reporting of incidents of actual or potential inadvertent oral administration of potassium permanganate concentrate in all care settings.
8. The British Association of Dermatologists has issued guidance on minimising harm from potassium permanganate soaks (April 2022).