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  

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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.