From the Guidelines
For treating a scalp abscess in a pediatric patient, the recommended oral antibiotic is typically clindamycin at a dose of 10-30 mg/kg/day divided into three or four doses for 7-10 days, as it provides coverage for both Staphylococcus aureus and Streptococcus species, which are the most common causative organisms in scalp abscesses 1.
Key Considerations
- Incision and drainage of the abscess remains the primary treatment, with antibiotics usually started after this procedure.
- The choice of antibiotic should target the most common causative organisms, which are Staphylococcus aureus and Streptococcus species.
- Small, uncomplicated abscesses may not require antibiotics after adequate drainage, but larger abscesses or those in patients with systemic symptoms, fever, surrounding cellulitis, or immunocompromise may benefit from antibiotic therapy.
- Clindamycin is a suitable option, especially if MRSA is suspected or the patient has a penicillin allergy, as it has been shown to be effective against CA-MRSA in pediatric patients 1.
Important Factors to Consider
- Assess the patient for signs of systemic infection and ensure adequate follow-up within 24-48 hours to evaluate treatment response.
- Consider the patient's age, weight, and any potential allergies when selecting an antibiotic.
- Be aware of the potential for antibiotic resistance and adjust treatment accordingly.
- Consider alternative antibiotics, such as cephalexin, if clindamycin is not suitable for the patient.
Additional Recommendations
- For patients with systemic toxicity or rapidly progressive infection, inpatient management and surgical intervention may be necessary.
- Cultures from abscesses and other purulent skin and soft tissue infections are recommended to guide antibiotic therapy and detect potential resistance patterns 1.
From the FDA Drug Label
Pediatric Patients: For all pediatric patients weighing less than 45 kg with severe or life-threatening infections (e.g., anthrax, Rocky Mountain spotted fever), the recommended dosage is 2.2 mg/kg of body weight administered every 12 hours. For pediatric patients with less severe disease (greater than 8 years of age and weighing less than 45 kg), the recommended dosage schedule is 4.4 mg/kg of body weight divided into two doses on the first day of treatment, followed by a maintenance dose of 2.2 mg/kg of body weight (given as a single daily dose or divided into twice daily doses).
The recommended oral antibiotic for treating a scalp abscess in a pediatric patient is doxycycline. The dosage is:
- For severe or life-threatening infections: 2.2 mg/kg of body weight every 12 hours for patients weighing less than 45 kg.
- For less severe disease (greater than 8 years of age and weighing less than 45 kg): 4.4 mg/kg of body weight divided into two doses on the first day, followed by 2.2 mg/kg of body weight per day. For patients weighing 45 kg or more, the adult dose should be used 2.
From the Research
Recommended Oral Antibiotics for Scalp Abscess in Pediatric Patients
- The treatment of choice for oral antibacterials for scalp abscess in pediatric patients remains the penicillinase-resistant penicillins such as flucloxacillin 3.
- Cefalexin and erythromycin are suitable cost-effective alternatives with broader cover, although care must be taken with the use of macrolides because of development of resistance to multiple families of antibacterials, particularly the lincosamides 3.
- Other cephalosporins such as cefadroxil and cefprozil are also effective, can be given once daily and have a better tolerability profile -- while azithromycin has a further advantage of a 3-day course 3.
- For uncomplicated skin infections, including abscesses, clindamycin and trimethoprim-sulfamethoxazole (TMP-SMX) have been shown to be effective 4, 5.
- Clindamycin is a treatment option for methicillin-resistant Staphylococcus aureus (MRSA) infections in children, but there is a risk of developing resistance during treatment 6.
Considerations for MRSA Infections
- MRSA infections are still relatively uncommon in children, but the incidence is increasing 7.
- Clindamycin and TMP-SMX are effective against MRSA, but the choice of antibiotic should be based on the susceptibility of the isolate and the clinical situation 7, 4, 5.
- The use of clindamycin for MRSA infections should be done with caution, as there is a risk of developing resistance during treatment 6.