From the Guidelines
Urticaria in pediatric patients following a methicillin-resistant Staphylococcus aureus (MRSA) infection should be treated with non-sedating H1 antihistamines, such as cetirizine or loratadine, and the underlying MRSA infection should be adequately treated with appropriate antibiotics, such as clindamycin, trimethoprim-sulfamethoxazole, or linezolid, based on susceptibility testing 1.
Treatment Approach
- Non-sedating H1 antihistamines, such as cetirizine (0.25 mg/kg/day divided twice daily, maximum 10 mg/day) or loratadine (5 mg daily for children 2-6 years, 10 mg daily for older children), should be used as the first line of treatment for urticaria in pediatric patients following an MRSA infection.
- For severe cases, a short course of oral prednisone (1-2 mg/kg/day for 3-5 days, maximum 60 mg/day) may be necessary.
- Ensure the underlying MRSA infection has been adequately treated with appropriate antibiotics, such as:
- Clindamycin: 10–13 mg/kg/dose IV every 6–8 h (to administer 40 mg/kg/day) for hospitalized children with complicated skin and soft tissue infections (cSSTI) 1.
- Trimethoprim-sulfamethoxazole: 8–12 mg/kg/d (based on trimethoprim component) in either 4 divided doses IV or 2 divided doses PO 1.
- Linezolid: 600 mg PO/IV twice daily for children >12 years of age and 10 mg/kg/dose PO/IV every 8 h for children <12 years of age 1.
Symptomatic Relief
- Cool compresses and lukewarm baths with colloidal oatmeal can provide symptomatic relief for urticaria.
- Parents should be advised to avoid potential triggers, including hot baths, vigorous exercise, and NSAIDs, during the acute phase.
Duration and Referral
- The urticaria typically resolves within 1-2 weeks but may persist longer in some cases.
- If urticaria persists beyond 6 weeks or recurs frequently, referral to a pediatric allergist or dermatologist is recommended to rule out other causes.
From the Research
Urticaria Post MRSA Infection in Pediatrics
There are no research papers to assist in answering this question directly, as the provided studies focus on the treatment and antimicrobial susceptibility of MRSA infections in pediatrics, rather than the specific condition of urticaria post MRSA infection.
Related Information on MRSA Infections
- MRSA remains a significant pathogen in the pediatric population, with various therapeutic agents available for treatment 2.
- The choice of antibiotic for MRSA infections should be based on in-vivo effectiveness, rather than in-vitro susceptibility data 3.
- Vancomycin, linezolid, tedizolid, and daptomycin are commonly used antibiotics for treating MRSA-caused complicated skin and soft tissue infections, with linezolid showing superiority in clinical and microbiological success in some studies 4.
- Linezolid has been shown to be an effective treatment for patients with and without vascular disease who have a lower-extremity complicated skin and skin structure infection caused by MRSA 5.
Antibiotic Susceptibility Patterns
- Methicillin-sensitive S. aureus (MSSA) is more prevalent than MRSA in pediatric atopic dermatitis patients, with first-generation cephalosporins remaining appropriate empiric therapy for most patients 6.
- MRSA susceptibility patterns vary, with some studies showing high susceptibility rates to doxycycline and trimethoprim-sulfamethoxazole (TMP-SMX) 6.