Clinical definition:
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 | |||
| Drug | Formulation | Dosage | Duration |
| 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.
Notes:
- 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.