From the Guidelines
Pediatric cellulitis is typically treated with antibiotics targeting common skin pathogens like Streptococcus species, with a 5-day course of antimicrobial therapy being as effective as a 10-day course if clinical improvement has occurred by 5 days, as recommended by the Infectious Diseases Society of America 1. When managing pediatric cellulitis, it is essential to consider the severity of the infection and the presence of systemic symptoms.
- For mild cases without systemic symptoms, oral antibiotics such as penicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin, cephalexin, or clindamycin are suitable options, with the choice of antibiotic depending on the suspected causative pathogen and local resistance patterns 1.
- In areas with high MRSA prevalence, consider using antibiotics effective against MRSA, such as clindamycin or trimethoprim-sulfamethoxazole, as recommended by the Infectious Diseases Society of America 1.
- For moderate to severe cases with systemic symptoms, hospitalization for intravenous antibiotics may be necessary, with options including cefazolin or clindamycin, and treatment duration depending on clinical response but generally continuing for 7-10 days.
- Supportive care, including elevation of the affected area, warm compresses, and pain management with acetaminophen or ibuprofen, is also crucial in managing pediatric cellulitis. It is worth noting that the choice of antibiotic and treatment duration should be guided by clinical judgment and local resistance patterns, with the goal of minimizing morbidity, mortality, and improving quality of life for pediatric patients with cellulitis 1.
From the Research
Treatment for Pediatric Cellulitis
The treatment for pediatric cellulitis typically involves the use of antibiotics. According to 2, oxacillin or cefalotin can be effective in treating uncomplicated cellulitis in regions where community-acquired methicillin-resistant S. aureus is infrequent.
Antibiotic Options
- Clindamycin and trimethoprim-sulfamethoxazole are also considered effective treatments for uncomplicated skin infections, including cellulitis, as shown in 3.
- Ampicillin-sulbactam, ceftriaxone, metronidazole, clindamycin, amoxicillin, amoxicillin-clavulanate, cefuroxime, and vancomycin are often used in the treatment of orbital and preseptal cellulitis, as mentioned in 4.
- Cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone can be used for treatment of uncomplicated cellulitis, but the addition of trimethoprim-sulfamethoxazole to cephalexin did not improve outcomes overall or by subgroup, as found in 5.
Management and Disposition
- The management of children with uncomplicated cellulitis in emergency and hospital settings involves determining the route of antibiotic administration and disposition, as discussed in 6.
- Features such as fevers/chills, lymphangitis, and functional impairment are considered important when deciding on initiating intravenous antibiotics, while stability of erythematous margins and clinical improvement criteria are considered important when deciding on readiness for oral antibiotics.
- Consensus recommendations can aid in decision making and improve standardization of clinical practice for the treatment and disposition of children with uncomplicated cellulitis.