Managing pediatric cellulitis made easier by early diagnosis

The number of children sent to the ED for skin and soft-tissue infections almost tripled from 1997 to 2005, suggesting a greater need for education in the diagnosis and treatment of pediatric cellulitis.

“Familiarity with the microbiology of these infections, as well as the signs of a severe infection are needed to provide the most appropriate care for these children,” Andrew Shriner, MD, and Laurie Wilkie, MD both professors of clinical pediatrics at Riley Hospital for Children at Indiana University Health wrote in Pediatric Annals.

Diagnosing and testing

Obtaining a thorough patient history, combined with performing an exam of the patient’s body will lead to most diagnoses, Shriner and Wilkie wrote. Most infections occur on the patient’s buttocks or lower extremities, and the infected areas that are tender, warm, or experiencing swelling and erythema are often indicative of pediatric cellulitis.

They also noted that laboratory testing may be required for children with infections who also have compromised immune systems, “severe systemic symptoms” and “complicated” infections. Imaging is often not necessary, but ultrasounds may prove beneficial if there is concern that an abscess exists.

Cellulitis treatment

“As with most infections in the era of antimicrobial stewardship, the goal for treatment of cellulitis is to use the antibiotic with the narrowest spectrum of activity necessary to adequately treat the infection,” Shriner and Wilkie wrote.

Mild cases of pediatric cellulitis can be treated with clindamycin, cephalexin, dicloxacillin, amoxicillin or penicillin. In cases where Staphylococcus aureus, especially MRSA, is suspected, Shriner and Wilkie recommended trimethoprim-sulfamethoxazole, doxycycline or clindamycin. In most “uncomplicated” pediatric cellulitis cases, 5 to 10 days of one of these medications should be sufficient for treatment, but further research is necessary to definitively ascertain the best course of antibiotics that should be taken.

When hospitalization is needed

According to the authors, children with cellulitis experiencing lethargy, different than normal mental status, hypotension, body temperatures below 36 C and above 38 C, tachypnea or tachycardia abnormal for their age or white blood cell count greater than 12,000 cells/mm³ should raise concerns of a more severe infection.

The average length of a hospital stay for patients with pediatric cellulitis is now fewer than 3 days following reduction or resolution of erythema, pain and swelling.

“Appropriate diagnosis and treatment of [skin and soft-tissue infections] has always been important for the general pediatrician,” Shriner and Wilkie wrote. “The increasing number of children presenting with SSTIs and the greater proportion of those requiring hospitalization, however, have raised the stakes for this common pediatric problem.”

More than 74,000 SSTI-related hospital admissions occur each year, according to the authors. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.