Management of Staphylococcal Vesicles in Children

Yes, you should lance a staphylococcal vesicle on a child as part of appropriate management of purulent skin and soft tissue infections. 1

Rationale for Incision and Drainage

Incision and drainage is the primary treatment for staphylococcal abscesses and purulent skin infections in children 1
For cutaneous abscesses, the main treatment is incision and drainage, which is likely adequate for most simple abscesses 1
Cultures from abscesses and other purulent skin and soft tissue infections (SSTIs) should be obtained in children treated with antibiotic therapy, those with severe local infection, signs of systemic illness, or those who have not responded to initial treatment 1

After drainage, empiric antibiotic coverage for community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) should be considered, especially if the child does not respond to beta-lactam therapy or shows systemic toxicity 1
For children with minor skin infections and secondarily infected skin lesions, mupirocin 2% topical ointment can be used 1
For children requiring systemic antibiotics who are stable without ongoing bacteremia:
- Clindamycin 10-13 mg/kg/dose IV every 6-8 hours (to administer 40 mg/kg/day total) is recommended if local clindamycin resistance rates are low (e.g., <10%) 1, 2
- For oral therapy, clindamycin can be administered at 30-40 mg/kg/day divided into 3-4 doses 2
- Trimethoprim-sulfamethoxazole (TMP-SMX) is an alternative for MRSA coverage, but lacks activity against streptococci 1

Keep draining wounds covered with clean, dry bandages 1
Maintain good personal hygiene with regular bathing and cleaning of hands with soap and water or an alcohol-based hand sanitizer 1
Avoid reusing or sharing personal items (e.g., disposable razors, linens, and towels) that have contacted infected skin 1

For recurrent staphylococcal infections, consider decolonization strategies in conjunction with hygiene measures 1:
- Nasal decolonization with mupirocin twice daily for 5-10 days 1
- Topical body decolonization with chlorhexidine or dilute bleach baths (1 teaspoon per gallon of water, 15 minutes twice weekly for 3 months) 1
Focus environmental cleaning efforts on high-touch surfaces that may contact bare skin 1

Do not use tetracyclines in children under 8 years of age 1
Avoid using rifampin as a single agent or as adjunctive therapy for the treatment of skin and soft tissue infections 1
For hospitalized children with complicated skin and soft tissue infections (cSSTI), vancomycin is recommended, especially if MRSA is suspected 1
While incision and drainage is the mainstay of therapy, antibiotic selection should be guided by local resistance patterns and clinical response 3
Supportive management, including regular wound cleaning, plays a vital role in ensuring cure 3

By following these guidelines, the management of staphylococcal vesicles in children can be optimized to improve outcomes and reduce complications.