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Pediatric cellulitis treatment varies by location and severity. Facial cellulitis requires hospitalization and broad-spectrum antibiotics, while extremity infections often respond to targeted S. aureus therapy.
Area of Science:
- Pediatrics
- Infectious Diseases
- Dermatology
Background:
- Cellulitis is a common bacterial skin infection in children.
- Prompt diagnosis and appropriate antibiotic therapy are crucial for effective management.
Purpose of the Study:
- To investigate the clinical presentation and microbiological findings of pediatric cellulitis.
- To evaluate the effectiveness of current treatment strategies and provide recommendations.
Main Methods:
- Prospective study of 20 children (ages 2-12) with cellulitis.
- Inclusion of complete blood count, blood culture, and lesion aspirate culture.
- Assessment of factors influencing hospitalization and outpatient antibiotic choices.
Main Results:
- Leg cellulitis was most common (70%), followed by upper extremity (20%).
- Haemophilus influenzae and Staphylococcus aureus were the most common pathogens identified.
- Outpatient treatment showed high response rates, with exceptions for severe cases.
Conclusions:
- Facial cellulitis warrants admission and broad-spectrum antibiotics (oxacillin and chloramphenicol).
- Extremity cellulitis initially treated against S. aureus may require broader coverage if fever or elevated WBC count is present.
- Cultures are essential for guiding therapy, especially in severe or facial presentations.
Abstract:
We prospectively studied 20 children, ages 2 to 12 years, seen with cellulitis. Each child had a complete blood count, a blood culture, and a culture of an aspirate from the lesion. The age of the child, the fever, and the extent of cellulitis determined whether the child was hospitalized. Outpatient antibiotic therapy was penicillin or dicloxacillin. Four children (20%) had an infection on the upper extremity: 14 (70%), the leg; 1 (5%), the forehead; and one (5%), the periorbital area. Three children (15%) had a white blood cell (WBC) count greater than or equal to 15,000 cu mm. Two were febrile. One child with a WBC count less than or equal to 15,000 cu mm was febrile. Two blood cultures (10%) were positive, both for Haemophilus influenzae. Twelve organisms were isolated from the aspirates: 8 Staphylococcus aureus (all penicillinase producing), 2 H influenzae, 1 Streptococcus pyogenes, and 1 Pseudomonas aeruginosa. Both children with H influenzae were febrile with WBC counts greater than or equal to 15,000 cu mm. Of the 17 children (85%) treated as outpatients, all but one responded. We recommend admission and cultures of the blood and an aspirate of the lesion for all facial cellulitis and treatment with oxacillin and chloramphenicol. In a truncal or extremity cellulitis, initial therapy should be directed against S aureus. If the child is febrile or the WBC count greater than or equal to 15,000 cu mm, H influenzae is a likely pathogen and thus intravenous chloramphenicol must be used after cultures are obtained.