Patient Population: Pediatric
Condition Major Pathogens  First Choice Therapy Alternative Therapy Comments
Abscess of skin/soft tissue  

Staphylococcus aureus 

Other pathogens depending on specific exposures/risk factors 

Incision and drainage (I&D) is recommended for source control, though previous recommendations suggested I&D alone as an option for small abscesses without surrounding cellulitis, more recent studies have shown faster resolution when antibiotic therapy is given following I&D   

Outpatient/non-severe infection

25 mg/kg/dose (max 500 mg/dose) enterally tid  


Inpatient/need for IV therapy

25 mg/kg/dose (max 2000 mg/dose) IV q8h  

Severe infection (hemodynamic instability, end-organ dysfunction, or extensive local progression)

ID consult  

Penicillin or cephalosporin allergy with higher risk for allergic reaction 


History of documented MRSA infection or carriage within the last 6 months 


MRSA identified and susceptible to trimethoprim- sulfamethoxazole 


Age >=1 month:  

Trimethoprim-sulfamethoxazole (Bactrim)
5 mg trimethoprim/kg/dose (max 160 mg trimethoprim/dose) enterally bid 

Severe infection (hemodynamic instability, end-organ dysfunction, or extensive local progression)

ID consult 

With abscess I&D, send routine bacterial culture, follow-up result and modify therapy as indicated 

Duration: 5 days following source control for non-severe infection 



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. 

Chen AE, et al. Randomized controlled trial of cephalexin versus clindamycin for uncomplicated pediatric skin infections. Pediatrics. 2011 Mar;127(3):e573-80. 

Daum RS, et al. A placebo-controlled trial of antibiotics for smaller skin abscesses. N Engl J Med 2017;376:2545-2555.

American Academy of Pediatrics. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2021.  

Pediatric Empiric Antimicrobial Therapy Guidelines

This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites. 

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. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.  

For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK. 

The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.