Child Health  |  Cellulitis




Child Health

Cellulitis

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  • Cellulitis a diffuse, spreading acute inflammation of the skin, soft tissue or connective tissue, which can appear as red and swollen skin.
  • Erysipelis a superficial form of cellulitis with prominent lymphatic involvement, presenting as a painful lesion with an indurated and erythematous border.
  • The most common causative organisms are Streptococcus pyogenes (group A β-haemolytic streptococcus or GAS) and Staphylococcus aureus (Staph aureus).
  • Cellulitis associated with furuncles, carbuncles or abscesses is usually caused by S. aureus.
  • Systemic symptoms such as fever, chills, nausea and vomiting may accompany or precede the skin changes.
  • This process can be rapid or take several days.
  • Limbs are most often affected but cellulitis can occur anywhere on the body.

 

Complications of cellulitis can include:

  • Local suppuration and skin necrosis.
  • Deeper abscesses within the body (e.g. muscle, kidneys, bone and brain).
  • Septicaemia.
  • Osteomyelitis and septic arthritis.
  • Acute glomerulonephritis.
  • Endocarditis.
  • Recurrent cellulitis causing persistent lymphoedema.

 

Cellulitis Treatment:

Oral Antibiotics

  • Choose the appropriate antibiotic according to site of cellulitis, etiology, presence or absence of penicillin allergy, and ability of child to swallow tablets (see algorithm).
  • Duration of therapy: 7-10 days.

Flucloxacillin

  1. Very effective against S.aureus and has adequate cover for S.pyogenes.

  2. Use for torso and limb cellulitis.

  3. As flucloxacillin is not palatable in the liquid form, amoxycillin and clavulanic acid may be a more suitable alternative in a child requiring a syrup.

  4. PO 50 mg/kg/day in three to four divided doses up to a max. 500 mg/dose on an empty stomach.
    A simple guide for flucloxacillin dosage is:

    • <2 years Flucloxacillin 125mg/5ml 2.5ml qid
    • 2-5 years Flucloxacillin 125mg/5ml 5ml qid
    • >5 years Flucloxacillin 250 mg/5ml 5ml qid (using 50 mg/kg/day as a cross check).

Amoxycillin + Clavulanic Acid

  • Has a much broader spectrum and is best reserved for puncture wounds, facial cellulitis, animal and human bites, and oral therapy for those children unable to ingest capsules/tablets.
  • PO 40mg/kg/day* in three divided doses up to a max. 500mg/dose with food.

* Doses expressed as amoxicillin component.

Erythromycin

The drug of choice when there is penicillin allergy.

  • PO 40mg/kg/day in four divided doses up to a max. 500mg/dose with or without food.
  • If there is a history of MRSA infection empirical therapy should be guided by previous susceptibility data.

IV Antibiotics

  • Usually an indication for admission
  • Community IV antibiotics using Community Primary Options (CPO) can be considered and may be tolerated in an older child >12. 



Advice for patients with Cellulitis:

1.  Advise about symptomatic treatment:

  • Use paracetamol or ibuprofen for pain and fever.
  • Drink adequate fluids to prevent dehydration.
  • Rest and or elevate the affected area for comfort and to relieve oedema (where applicable).

2.  Advise to keep the child at home until mobility is normal and child is well.  



Last updated : Thursday, May 18, 2017
Next review date : Friday, May 18,2018


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