Related Experiment Video
Updated: Jul 10, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 9, 2011
Management of cellulitis in a pediatric emergency department
Simi Khangura1, Jonathan Wallace, Niranjan Kissoon
1Division of Emergency Medicine, Departments of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Oral antibiotics are effective for treating non-facial cellulitis in children, requiring fewer emergency department visits and less treatment time compared to IV antibiotics. Cefazolin with probenecid showed fewer treatment failures than cefazolin alone.
Area of Science:
- Pediatric infectious diseases
- Dermatology
- Pharmacology
Background:
- Cellulitis is a common bacterial skin infection in children.
- Treatment decisions for pediatric cellulitis involve antibiotic choice, route of administration, and healthcare resource utilization.
- Understanding outcomes for outpatient management is crucial for optimizing pediatric care.
Purpose of the Study:
- To evaluate antibiotic choices and outcomes for children with non-complicated, non-facial cellulitis treated as outpatients.
- To assess emergency department (ED) visit frequency and duration for cellulitis treatment in children.
Main Methods:
- A descriptive case-control study was conducted.
- Medical records of children aged 1-16 years with non-complicated, non-facial cellulitis were reviewed over a 3-year period.
- Data included demographics, clinical presentation, management, and treatment outcomes.
Main Results:
- Cephalexin was the most common oral antibiotic; 8.9% treatment failure.
- Cefazolin was the most common intravenous antibiotic.
- Intravenous treatment resulted in significantly more ED time and visits compared to oral treatment.
Conclusions:
- First-generation cephalosporins are commonly used for non-facial cellulitis in children.
- Oral antibiotic treatment is effective, efficient, and requires fewer ED resources.
- Intravenous cefazolin with probenecid may be a superior alternative to cefazolin alone for hospitalized children.
Objectives:
(1) To determine antibiotic choices, route of administration, and outcomes of children treated as outpatients with noncomplicated, nonfacial cellulitis at a tertiary care center. (2) To determine the number of visits and time spent in the emergency department (ED) for treatment.
Design:
A descriptive case-control study.
Setting:
A tertiary care pediatric ED at an academic medical center.
Methods:
Medical records of all otherwise healthy children (aged 1-16 yrs) presenting with noncomplicated, nonfacial cellulitis over a 3-year period (January 1, 2001-December 31, 2003) were reviewed. Data extracted included the following: demographics; clinical presentation; laboratory and microbiology results; management, including choice, dose, and route of antibiotic(s); treatment failures; and time spent in the ED.
Interventions:
None.
Main Results:
Two hundred sixty-nine patients met the inclusion criteria, and their charts were selected for review. The oral antibiotic most often prescribed was cephalexin (N = 105). Treatment failure occurred in 10 (8.9%) of the cases. The intravenous antibiotic most often prescribed was cefazolin (N = 124; 39 received cefazolin alone, and 85 received cefazolin and probenecid). The cefazolin-only group had 12 (31%) treatment failures, whereas the cefazolin and probenecid group had 7 (8.1%) treatment failures. More time in the ED (521 +/- 287 minutes) and more visits (3.4 +/- 2.8) were seen in the intravenous group as compared with the oral group (time in ED, 164 +/- 139 minutes; visits, 1.4 +/- 1).
Conclusions:
Noncomplicated, nonfacial cellulitis is most commonly treated using first-generation cephalosporins. Treatment with oral antibiotics was effective and required fewer visits and less time in the ED compared with intravenous treatment. Twice-daily cefazolin and probenecid was associated with less treatment failures and admissions than cefazolin alone and may represent a reasonable alternative for children with nonfacial cellulitis requiring intravenous antibiotics.
Related Concept Videos
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:17Urinary Tract Infection IV: Nursing Management
01:26Tonsillitis II: Management
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:29Endocarditis IV: Nursing Management