Discharge Instructions for a 9-Year-Old with Buttock Cellulitis
For a 9-year-old with cellulitis on the buttock, warm water soaking is recommended as part of discharge instructions, along with elevation of the affected area, antibiotic therapy for 5 days, and monitoring for improvement. 1
Antibiotic Therapy
- Prescribe a 5-day course of antibiotics active against streptococci (the most common cause of cellulitis) 1
- Suitable oral antibiotics include:
- Cephalexin
- Amoxicillin-clavulanate
- Dicloxacillin
- Clindamycin (if penicillin allergic) 1
- Extend treatment beyond 5 days only if the infection has not improved within this time period 1
- MRSA coverage is generally unnecessary for typical cellulitis unless there are specific risk factors (e.g., purulent drainage, evidence of MRSA elsewhere) 1, 2
Home Care Instructions
- Elevate the affected area to promote gravity drainage of edema and inflammatory substances 1
- Apply warm compresses or soak the affected area in warm water to improve circulation and reduce inflammation 1
- Keep the skin clean and well-hydrated with emollients to prevent dryness and cracking 1
- Monitor for signs of worsening infection:
- Increasing redness, swelling, or pain
- Fever or chills
- Appearance of pus or drainage
- Lack of improvement after 48 hours of antibiotic therapy 2
Follow-up Care
- Schedule follow-up appointment in 5-7 days to assess response to treatment 1
- Return sooner if symptoms worsen or fail to improve within 48 hours 1
- Assess for and treat any predisposing factors to prevent recurrence 1, 3
Prevention of Recurrence
- Identify and treat any underlying skin conditions (e.g., eczema, tinea) 1
- Maintain good skin hygiene 1
- Avoid skin trauma and protect the area from injury 3
- Treat any breaks in the skin promptly with gentle cleansing and topical antibiotics if needed 4
When to Seek Immediate Medical Attention
- If fever develops or increases 1
- If the redness or swelling spreads rapidly 1, 2
- If severe pain develops 2
- If the child appears systemically unwell 1
Important Considerations
- Cutaneous inflammation may sometimes worsen after initiating therapy due to the sudden destruction of pathogens releasing enzymes that increase local inflammation - this is expected and should improve with continued treatment 1
- Avoid using adhesive bandages directly on the affected area as they may further irritate the skin 5
- Ensure the child takes the full course of antibiotics even if symptoms improve before completion 1