Cellulitis

Patient Population: Pediatric
Condition Major Pathogens  First Choice Therapy Alternative Therapy Comments
Cellulitis without associated abscess of skin/soft tissue 

Group A streptococcus 

Staphylococcus aureus  

Outpatient

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

--------------------- 

Inpatient/need for IV therapy

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

Penicillin or cephalosporin allergy with higher risk for allergic reaction

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

OR  

Clindamycin
10 mg/kg/dose (max 600 mg/dose) enterally tid 

Duration: 5 days for non-severe infection 

ID consult recommended for severe infection, indicated by hemodynamic instability, end-organ dysfunction, or extensive local progression  

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. 

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.