From the Guidelines
Antibiotics recommended for a one-year-old child with multiple skin abscesses, lymphadenitis, and failure to thrive are clindamycin, TMP-SMX, or linezolid.
Treatment Options
- Clindamycin: 10–13 mg/kg/dose PO every 6–8 h, not to exceed 40 mg/kg/day 1
- TMP-SMX: Trimethoprim 4–6 mg/kg/dose, sulfamethoxazole 20–30 mg/kg/dose PO every 12 h 1
- Linezolid: 10 mg/kg/dose PO every 8 h, not to exceed 600 mg/dose 1
Key Considerations
- Incision and drainage is the primary treatment for cutaneous abscesses, but antibiotics may be necessary for complicated cases, such as multiple abscesses, lymphadenitis, and failure to thrive 1
- The choice of antibiotic should be based on local epidemiology and susceptibility patterns, as well as the severity of the infection 1
- Clindamycin is effective against both CA-MRSA and b-hemolytic streptococci, but its use should be cautious due to the risk of Clostridium difficile-associated disease 1
- TMP-SMX and linezolid are also effective options, but their use should be guided by local susceptibility patterns and the severity of the infection 1
From the Research
Antibiotic Recommendations for a One-Year-Old Child with Multiple Skin Abscesses, Lymphadenitis, and Failure to Thrive
- The choice of antibiotic should be guided by the likely pathogens, which include Staphylococcus aureus and Streptococcus pyogenes 2, 3, 4.
- For uncomplicated skin abscesses, antibiotics such as trimethoprim and sulfamethoxazole (TMP-SMX) or clindamycin may be considered, as they have been shown to reduce the risk of treatment failure and recurrence 5.
- However, clindamycin has a higher risk of gastrointestinal side effects, including diarrhea, compared to TMP-SMX 5.
- For lymphadenitis, narrow-spectrum beta-lactam therapy, such as flucloxacillin, may be effective in uncomplicated cases 3.
- In cases of complicated disease, such as abscess formation, broader-spectrum antibiotics, including cephalosporins or clindamycin, may be necessary 3, 6, 4.
- The use of amoxicillin-clavulanate has been recommended for dermohypodermitis and may be an option for skin abscesses and lymphadenitis 2, 6.
- It is essential to consider the resistance profile of the target pathogen, the agent's antibacterial profile, and its pharmacokinetic properties when selecting an antibiotic 2.
Factors to Consider in Antibiotic Selection
- The severity and type of infection, including the presence of abscesses or lymphadenitis 2, 3, 6.
- The likelihood of methicillin-resistant Staphylococcus aureus (MRSA) infection, which may require broader-spectrum antibiotics 3, 4.
- The patient's age, weight, and renal function, which may affect the choice of antibiotic and dosage 2, 6.
- The potential for adverse effects, including gastrointestinal side effects and diarrhea 5.