From the Guidelines
For treating staph infections in children, the first-line antibiotic is typically clindamycin, given at a dose of 10-30 mg/kg/day divided into three or four doses, especially if MRSA (methicillin-resistant Staphylococcus aureus) is suspected, as recommended by the Infectious Diseases Society of America in their 2014 guidelines 1. The choice of antibiotic depends on the severity and location of the infection, local resistance patterns, and whether the child has any allergies.
- For mild skin infections, topical mupirocin (Bactroban) applied three times daily for 5-10 days may be sufficient.
- For more severe infections, such as purulent cellulitis, clindamycin is recommended at a dose of 10-13 mg/kg/dose PO every 6-8 h, not to exceed 40 mg/kg/day 1.
- It's essential to complete the full course of antibiotics even if symptoms improve quickly, as staph bacteria can develop resistance.
- Cultures may be needed to determine the most effective treatment, especially in cases of severe or recurrent infections.
- Supportive care, including keeping the infected area clean, applying warm compresses, and ensuring adequate pain control, is also crucial.
- If the infection worsens despite treatment, shows signs of spreading, or if the child develops fever or appears ill, immediate medical reevaluation is necessary, and intravenous antibiotics may be required, such as vancomycin, which is recommended for severe or extensive disease, including MRSA infections 1.
From the FDA Drug Label
Vancomycin Hydrochloride for Injection, USP is indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (β-lactam-resistant) staphylococci The best antibiotic for staph infection in children is vancomycin, as it is effective against methicillin-resistant staphylococci and has been documented to be effective in various staphylococcal infections, including septicemia, bone infections, and skin and skin structure infections 2.
- Key points:
- Vancomycin is effective against methicillin-resistant staphylococci
- It has been documented to be effective in various staphylococcal infections
- It should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria
From the Research
Antibiotic Treatment for Staph Infections in Children
- The optimal treatment for uncomplicated skin/soft tissue infections (SSTIs) in pediatric patients is 5 days of cephalexin for nonpurulent SSTIs and 7 days of clindamycin or trimethoprim/sulfamethoxazole for purulent SSTIs 3.
- For methicillin-resistant Staphylococcus aureus (MRSA) infections, the treatment options are more limited, and the choice of antibiotic depends on the severity of the infection and the patient's clinical status 4.
- Ceftriaxone has been evaluated as a potential treatment option for methicillin-susceptible Staphylococcus aureus (MSSA) infections, and studies have shown that it is associated with a lower risk of toxicity requiring therapy alteration compared to antistaphylococcal antibiotics (ASAs) 5.
- For MRSA bacteremia, the current Infectious Disease Society Of America (IDSA)-recommended antibiotics are vancomycin and daptomycin, but newer agents such as ceftaroline have shown promise in combination with daptomycin 6.
- Other antibiotics such as trimethoprim-sulfamethoxazole, clindamycin, doxycycline, and minocycline have been used to treat MRSA pneumonia, but the evidence for their effectiveness is limited, and randomized controlled trials are needed to determine their efficacy 7.
Considerations for Antibiotic Choice
- The choice of antibiotic should be based on the severity of the infection, the patient's clinical status, and the susceptibility of the infecting organism to the antibiotic.
- The duration of antibiotic treatment should be optimized to minimize the risk of antibiotic resistance and reduce the risk of adverse effects.
- Clinicians should consider the potential benefits and risks of each antibiotic option and base their decision on a case-by-case basis depending on the individual patient's needs.