What is the best antibiotic for a child with a soft tissue infection from onychotomy (nail cutting)?

From the Guidelines

For a child with a soft tissue infection from nail cutting, the first-line antibiotic treatment is typically cephalexin (Keflex) at a dose of 25-50 mg/kg/day divided into 4 doses for 5-7 days, as recommended by the Infectious Diseases Society of America 1 and supported by the WHO's essential medicines and aware recommendations 1. This recommendation is based on the high-quality evidence from well-performed studies, which suggests that cephalexin is effective against Staphylococcus aureus and Streptococcus species, the most common causes of soft tissue infections. Some key points to consider when treating soft tissue infections in children include:

• The use of antibiotics should be guided by the severity of the infection and the presence of systemic symptoms, such as fever or red streaking from the wound 1.
• Clindamycin can be used as an alternative to cephalexin, especially if MRSA is suspected or the child has a penicillin allergy, at a dose of 10-30 mg/kg/day divided into 3-4 doses 1.
• In addition to antibiotics, the wound should be cleaned with soap and water, and warm compresses can be applied several times daily to promote healing and reduce discomfort.
• Parents should monitor for worsening symptoms, such as increasing redness, swelling, warmth, pain, or the development of fever or red streaking from the wound, and seek medical attention if the infection does not improve within 48 hours of starting antibiotics or worsens at any point 1. It is essential to note that the treatment of soft tissue infections in children should be individualized based on the specific circumstances of each case, and healthcare providers should be consulted for guidance on the most appropriate treatment approach.

From the FDA Drug Label

Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci Serious skin and soft tissue infections; Pediatric Patients (for children who are able to swallow capsules): Serious infections – 8 to 16 mg/kg/day (4 to 8 mg/lb/day) divided into three or four equal doses.

The best antibiotic for a child with a soft tissue infection from cutting nails is clindamycin, with a dosage of 8 to 16 mg/kg/day for serious infections, divided into three or four equal doses 2 2.

From the Research

Antibiotic Treatment for Soft Tissue Infections in Children

• The bacterial targets for antibiotics in soft tissue infections are mainly Staphylococcus aureus (SA) and Streptococcus pyogenes 3, 4, 5, 6.
• For children with soft tissue infections, especially those that are superficial, careful washing and rinsing of the lesion are often sufficient and may not require systemic antibiotics 3, 4.
• The French Pediatric Infectious Disease Group recommends the use of amoxicillin + clavulanate as the first-line antibiotic in most children suffering from severe skin infections requiring antibiotic treatment, due to the low incidence of methicillin-resistant SA in France 3, 4.
• In patients presenting with toxinic symptoms and signs, the addition of an antibiotic with antitoxin properties such as clindamycin should be considered 3, 4, 5.
• For uncomplicated superficial skin infections justifying an oral antibiotic, amoxicillin-clavulanate offers the best guarantee of efficiency 5.
• In cases of allergy, alternative antibiotics such as first-generation cephalosporins, macrolides, or pristinamycine (after 6 years of age) can be used 5.

Considerations for Antibiotic Choice

• The choice of antibiotic should take into account the resistance of the bacterial species, pharmacokinetics-pharmacodynamic parameters, and the severity and type of infection 5.
• Bacterial wound cultures are important for characterizing local susceptibility patterns, and definitive antibiotic therapy should be based on these results 7.
• The response to therapy is expected within the first few days, and 5 to 7 days of therapy is typically adequate to achieve cure 7.