Pediatric Guidelines: Skin & Soft Tissue Infections - Non-Purulent Cellulitis

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Condition Major Pathogens First Choice Therapy Alternative Therapy Comments
Non-purulent cellulitis

Group A streptococcus

Staphylococcus aureus

Outpatient/non-severe infection:

Cephalexin 25mg/kg/dose PO TID (max 500mg/dose)

If suspected MRSA or failure of prior non-MRSA therapy:

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

Duration: 5-7 days for non-severe infection

Inpatient/need for IV therapy:

Cefazolin 25mg/kg/dose IV q8h (max 2g/dose)

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).