What is the approach to managing cellulitis in children according to the Royal Children's Hospital (RCH)?

From the Guidelines

The approach to managing cellulitis in children according to the Royal Children's Hospital (RCH) involves prompt assessment and appropriate antibiotic therapy, with a focus on covering streptococci and considering the severity of the infection.

Key Principles

• The choice of antibiotic should be active against streptococci, with options including penicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin, cephalexin, or clindamycin 1.
• For uncomplicated cellulitis, a 5-day course of antimicrobial therapy can be as effective as a 10-day course if clinical improvement has occurred by 5 days 1.
• The average duration of treatment is typically around 2 weeks, but this can vary depending on the severity of the infection and the patient's response to treatment 1.

Treatment Approach

• For mild cases, oral antibiotics such as penicillin or cephalexin can be used, while for more severe cases, intravenous antibiotics such as flucloxacillin may be necessary.
• It is essential to monitor the patient's response to treatment within 48 hours and consider adjusting the antibiotic coverage if there is no improvement.
• Adjunctive measures such as elevation of the affected limb, adequate pain management, and addressing underlying predisposing factors can help prevent recurrence and improve outcomes.

Important Considerations

• The treatment approach should target the most common causative organisms, including Staphylococcus aureus and Streptococcus pyogenes, while considering age-specific pathogens and local resistance patterns.
• In cases where there is no improvement with initial treatment, consideration should be given to MRSA coverage and other potential pathogens.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Approach to Managing Cellulitis in Children

The Royal Children's Hospital (RCH) approach to managing cellulitis in children involves the use of intravenous antibiotics, with the option of treatment at home or in the hospital.

• The RCH has been involved in studies comparing the efficacy and safety of intravenous antibiotic therapy at home with that of standard treatment in hospital for children with moderate to severe cellulitis 2, 3.
• The studies have shown that home treatment with intravenous ceftriaxone is not inferior to treatment in hospital with intravenous flucloxacillin for children with cellulitis 3.
• The RCH has implemented a pathway for children to be treated with intravenous antibiotics at home, which has been shown to be effective and safe 4.
• The goal of treatment is to use the antibiotic with the narrowest spectrum for the shortest duration necessary to provide clinical improvement 5.

Key Considerations

• The diagnosis and treatment of cellulitis can be challenging, and practitioners need to be skilled in recognizing the need for inpatient treatment 5.
• The use of intravenous antibiotics at home requires careful selection of patients and close monitoring to ensure safety and efficacy 2, 3, 4.
• The RCH approach to managing cellulitis in children is based on the latest research and aims to provide the best possible outcomes for patients 2, 3, 4.

Treatment Options

• Intravenous ceftriaxone at home is a viable option for children with uncomplicated moderate to severe cellulitis 3, 4.
• Intravenous flucloxacillin in hospital is also an effective treatment option for children with cellulitis 3.
• The choice of treatment depends on the individual patient's needs and circumstances, and should be made in consultation with a healthcare professional 2, 3, 4.