From the Guidelines
For infected skin bites in children, amoxicillin-clavulanate (Augmentin) is typically the first-choice antibiotic due to its effectiveness against the mixed bacterial flora commonly found in bite wounds, as recommended by the most recent guidelines 1. The usual pediatric dosage is 45 mg/kg/day divided into two doses for 5-7 days, though this may vary based on the child's weight and infection severity. Some key points to consider when treating infected skin bites in children include:
- The choice of antibiotic should target both aerobic and anaerobic bacteria commonly introduced through bites, including Staphylococcus, Streptococcus, Pasteurella (especially in cat bites), and various oral bacteria.
- For children with penicillin allergies, alternatives include clindamycin plus trimethoprim-sulfamethoxazole or, in less severe cases, cephalexin.
- Beyond antibiotics, proper wound care is essential: clean the wound with soap and water, apply antibiotic ointment, and cover with a clean bandage changed daily.
- Watch for signs of worsening infection such as increasing redness, swelling, warmth, pus, red streaking, fever, or increased pain, which would warrant immediate medical attention. It is always best to consult a healthcare provider for proper diagnosis and treatment, as they may need to examine the wound and consider factors like the bite source, wound depth, and the child's medical history 1.
From the FDA Drug Label
CLINICAL STUDIES The efficacy of topical mupirocin ointment in impetigo was tested in two studies. ... Pediatrics There were 91 pediatric patients aged 2 months to 15 years in the first study described above Clinical efficacy rates at end of therapy in the evaluable populations were 78% for mupirocin ointment (n=42) and 36% for vehicle placebo (n=49). In the second study described above, all patients were pediatric except two adults in the group receiving mupirocin ointment. The age range of the pediatric patients was 7 months to 13 years The clinical efficacy rate for mupirocin ointment (n=27) was 96%, and for erythromycin it was unchanged (78.5%).
Mupirocin ointment is a suitable option for treating infected skin bites in children, with clinical efficacy rates of 78% and 96% in two studies 2.
- The studies included pediatric patients aged 2 months to 15 years.
- Mupirocin ointment showed higher efficacy rates compared to erythromycin in one of the studies.
- No side effects were reported in the group receiving mupirocin ointment.
From the Research
Antibiotic Treatment for Infected Skin Bites in Children
The choice of antibiotic for infected skin bites in children depends on the severity and type of infection, as well as the suspected causative bacteria.
- For uncomplicated superficial skin infections, amoxicillin-clavulanate is often recommended as the first-line treatment 3, 4, 5.
- For more severe infections, such as dermohypodermitis, amoxicillin-clavulanate is also the preferred choice, and may be administered intravenously 3, 6.
- In cases of allergy or resistance, alternative antibiotics such as first-generation cephalosporins, macrolides, or pristinamycine may be used 3, 7.
- For infections suspected to be caused by methicillin-resistant Staphylococcus aureus (MRSA), clindamycin or trimethoprim/sulfamethoxazole may be considered 7, 6.
Topical Antibiotics
For limited impetigo or furonculosis, topical antibiotics such as mupirocin, fusidic acid, or retapamulin may be used 3, 7.