Pediatric Guidelines: Skin & Soft Tissue Infections - Abscess/Purulent Cellulitis

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Condition Major Pathogens First Choice Therapy Alternative Therapy Comments

Abscess with or without surrounding cellulitis

Surrounding cellulitis = marked erythema larger than the extent of overlying induration OR extending > 5cm from abscess for adult-sized patient

Staphylococcus aureus

Other pathogens depending on specific exposures/risk factors

Consider drainage alone if isolated abscess or minor surrounding cellulitis; antibiotic therapy recommended if significant surrounding cellulitis, unable to drain, severe infection, or immunocompromised patient

Outpatient/non-severe infection, > 1 month old:

Trimethoprim-sulfamethoxazole (Bactrim/Septra) 4-6 mg/kg/dose trimethoprim PO BID (max 160mg trimethoprim/dose)

Clindamycin 10mg/kg/dose IV/PO q8h (max 600mg/dose PO, 900mg/dose IV)

OR 

Doxycycline 2mg/kg/dose PO BID (max 100mg/dose) if >= 8 years old

Duration: 5-7 days for non-severe infection

See Antibiogram for inpatient and outpatient S. aureus susceptibilities

 

Severe infection:

Vancomycin 15mg/kg/dose IV q6-8h (initial max 1g/dose)

References:

Stevens DL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014;59:e10-e52. 

Liu C, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011;52:e18-e55. 

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).