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Published on: November 28, 2019
Outpatient management of moderate cellulitis in children using high-dose oral cephalexin
Evelyne D Trottier1, Beatrice Farley St-Amand1, Mélanie Vincent2
1Department of Paediatric Emergency Medicine, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada.
Insights
High-dose oral cephalexin effectively treats moderate cellulitis in children, with an 89.7% success rate. This outpatient approach reduces hospital admissions and the need for intravenous antibiotics.
Area of Science:
- Pediatric infectious diseases
- Dermatology
- Pharmacology
Background:
- Cellulitis is a common bacterial skin infection in children.
- Current treatment guidelines often involve hospitalization or intravenous antibiotics for moderate cases.
- Optimizing outpatient oral antibiotic regimens is crucial for reducing healthcare burden.
Purpose of the Study:
- To evaluate the effectiveness and safety of a high-dose oral cephalexin guideline for outpatient treatment of moderate pediatric cellulitis.
- To assess the rate of treatment failure, including hospital admission or need for intravenous therapy.
Main Methods:
- Retrospective cohort study of children with moderate cellulitis treated with high-dose oral cephalexin.
- Standardized follow-up at a medical day hospital (MDH) was implemented.
- Treatment failure was defined as admission, switch to IV treatment, or emergency department (ED) revisit within 2 weeks of discharge.
Main Results:
- 117 children received high-dose oral cephalexin, achieving an 89.7% success rate (105/117).
- Treatment failure occurred in 10.3% of cases (12/117), with 8.5% requiring admission.
- No severe complications were reported; four abscesses required drainage and one patient experienced a rash.
Conclusions:
- High-dose oral cephalexin demonstrates an 89.7% success rate in treating moderate pediatric cellulitis on an outpatient basis.
- This treatment approach appears safe and effective, potentially lowering hospitalization rates and reducing the need for intravenous antibiotic administration.
- The findings support the use of high-dose oral cephalexin as a viable alternative for managing moderate cellulitis in children.
Objectives:
To evaluate the effectiveness of a high-dose (HD) oral cephalexin treatment guideline for children with moderate cellulitis treated as outpatients.
Methods:
In this retrospective cohort study, we included children who presented to the emergency department (ED) with moderate cellulitis and treated according to the institution's HD oral cephalexin guideline over a 2-year period. All children had standardized follow-up at a medical day hospital (MDH). Treatment was considered effective in the absence of treatment failure, defined as admission, switch to IV treatment or ED visit within 2 weeks of discharge from the MDH. Safety was ascertained by recording adverse events and severe complications at follow-up.
Results:
A total of 123 children were treated as outlined in the guideline, including 117 treated with HD oral cephalexin. The success rate was 89.7% (105/117). Among 12 (10.3%) children who had treatment failure, 10 (8.5%) required admission, 1 (0.9%) received IV antibiotics at the MDH and 1 (0.9%) had a return visit to the ED without admission. No severe complications were reported; four abscesses required drainage and one patient had a rash. The mean number of visits per child at the MDH was 1.6 (SD 1.0).
Conclusions:
With a success rate of 89.7%, HD oral cephalexin seems effective and safe for the treatment of children with moderate cellulitis. Its use potentially reduces hospitalization rates for this condition and decreases the need for IV insertion.
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