Bacterial infections of skin and underlying soft tissue. Common bacterial pathogens include S. aureus and Group A Streptococcus species. Anaerobes may play a role in specific regions of the body including the perineum.
Neonate, Infant, Child & Adolescent
|Preferred antibiotic choice|
|Cloxacillin (IV)||Cloxacillin- Powder for injection: 500 mg (as sodium salt) in vial||o First week of life (7 days or less): 50 mg/kg/dose 12 hourly
o 8-28 days: 50 mg/kg/dose 8 hourly
o Older than 28 days: 25-50 mg/kg/dose 6 hourly, maximum dose 2 g 6 hourly
|5 – 7 days|
|If Cloxacillin (IV) is not available, use Cefazolin (IV).||Cefazolin- Powder for injection: 1 g (as sodium salt) in vial||
o First week of life (7 days or less): 50 mg/kg/dose 12 hourly
o 8 days & older: 50 mg/kg/dose 8 hourly, maximum dose 4 g 8 hourly
|For infants, children, and adolescents, switch to oral therapy when tolerated (Neonates should complete IV therapy):|
|Flucloxacillin (PO)||Capsules: 500 mg; 1 g (as sodium salt)||25 mg/kg/dose 6 hourly, maximum dose 500 mg 6 hourly||5 – 7 days
(Total treatment duration including IV therapy.)
|Alternative antibiotic choice for infants and children unable to swallow Flucloxacillin capsules:|
|Cefalexin (PO)||Powder for reconstitution with water: 125 mg/5 mL; 250 mg/5 mL; Solid oral dosage form: 250 mg (as monohydrate)||25 mg/kg/dose 6 hourly, maximum dose 1 g 6 hourly||5 – 7 days|
|In case of confirmed drug allergy or medical contraindication:|
|Clindamycin (IV/PO)||Oral liquid: 75 mg/5 mL (as palmitate). Capsule: 150 mg (as hydrochloride). Injection: 150 mg (as phosphate)/mL||6 mg/kg/dose 6 hourly, maximum dose 600 mg 8 hourly (IV) or 450 mg 6 hourly (PO)||5 – 7 days|
Principles of Stewardship:
- If the abscess can be incised and drained, withhold antibiotics for standard, uncomplicated abscess in an otherwise well person.
- If IV antibiotic therapy is indicated, review patient progress daily to consider switch from IV to oral therapy.
- For patients with suspected animal bite, assess for rabies risk and manage accordingly, and administer a tetanus booster dose if indicated.
- If necrotizing fasciitis is suspected (especially if in perineal area), use ceftriaxone plus metronidazole plus clindamycin or, alternatively, amoxicillin/clavulanic acid plus clindamycin (clindamycin included to suppress toxin production), and obtain urgent expert advice regarding surgical management.