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Infection/Condition and Likely Organism |
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Abscess Staphylococcus aureus |
Mild: *Cloxacillin 25-50mg/kg/ day PO in 4 divided doses (max. 1gm/day) for 5-7 days |
Cephalexin 25-50mg/ kg/day PO in 2 divided doses for 5-7days |
Incision and drainage (landD) is the MAINSTAY of therapy. Needle aspiration is inadequate, can sent pus obtained during landD for C&S.
Use parenteral route for severe infections. Consider CA-MRSA if poorly resolving. *Doses recommended in previous columns are for children weighing less than 25kg. For children weighing more than 25kg, use adult dosage (500mg PO q6h). |
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Severe: Cloxacillin 200mg/kg/day IV in 4 divided doses (max. 12gm/day) for 5-7 days |
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CA-MRSA: Clindamycin 30-40mg/ kg/day PO in 3-4 divided doses for 5-7 days OR Trimethoprim-sulfamethoxazole 8-10mg/kg/day (TMP dose) PO in 2 divided doses for 5-7 days |
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SKIN AND SOFT TISSUE INFECTIONS
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Pasteurella multocida, Staphylococcus spp., Streptococcus spp., Capnocytophaga spp., anaerobes |
Amoxicillin-clavulanate 45mg/kg/day PO in 2 divided doses for 5- 7 days |
Amoxicillin-clavulanate 30mg/kg/dose IV q8h (max. 1.2gm) |
Consider rabies prophylaxis. |
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Cellulitis Staphylococcus aureus Streptococcus pyogenes |
Cloxacillin 200mg/kg/day IV in 4 divided doses (max. 12gm/day) for 5-7 days |
Amoxicillin 25-50mg/ kg/day PO in 3 divided doses for 7 days OR Cephalexin 25-50mg/ kg/day PO in 2 divided doses for 5-7days |
Administer using parenteral route for extensive lesions. Total treatment until 3 days after acute inflammation disappears. |
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Hansen’s Disease (leprosy) in children |
Paucibacillary: 10-14 years old: Rifampicin 450mg PO monthly PLUS Dapsone 50mg PO daily
<10 years old: Rifampicin 10mg/kg PO monthly PLUS Dapsone 2mg/kg PO q24h
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Duration of treatment: 6 months Surveillance: 5 years |
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Multibacillary: 10-14 years old: Rifampicin 450mg PO monthly PLUS Dapsone 50mg PO q24h PLUS Clofazimine 150mg PO monthly and 50mg q48h
<10 years old: Rifampicin 10mg/kg PO monthly PLUS Dapsone 2mg/kg PO q24h PLUS Clofazimine 6mg/kg PO monthly and 1mg/kg PO q48h |
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Duration of treatment: 1-2 years. |
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Impetigo Staphylococcus aureus Streptococcus pyogenes |
Localised: Topical 2% Fusidic acid 2-3 times daily for 7 days outpatient Generalised: Cloxacillin 25-50mg/kg/ day PO (max. 1gm/day) in 4 divided doses for 5-7 days |
Cephalexin 25-50mg/ kg/day PO in 2 divided doses for 5-7 days |
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Necrotising fasciitis Streptococcus spp.: Group A Streptococcus (GABHS) Other Streptococcus spp. Staphylococcal: Staphylococcal aureus (MSSA and CA MRSA) |
Streptococcal necrotising fasciitis: Benzylpenicillin 200,000-300,000units/kg/ day IV in 4-6 divided doses PLUS Clindamycin 20-40mg/kg/ day IV in 3-4 divided doses max. 2.7gm/day) |
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50% of patients have associated streptococcal toxic shock syndrome (STSS). Aggressive surgical debridement of the deep-seated infection is the mainstay of therapy.
Combination therapy is needed with Clindamycin to block toxin production whether or not patient manifests toxic shock syndrome. Tissues should be sent for Gram staining and C&S. IVIG can be used as an adjunct, typically at 1 gm/kg on Day 1, followed by 0.5mg/kg on 1-2 subsequent days. |
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Staphylococcal necrotising fasciitis: Cloxacillin 200mg/kg/day IV in 4-6 divided doses PLUS Clindamycin 20-40mg/kg/ day IV (max. 2.7gm/day) in 3-4 divided doses |
If CA-MRSA is suspected: Vancomycin 60mg/kg/day IV in 3-4 divided doses (max. 2gm/day) |
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Staphylococcal Scalded skin syndrome (SSSS) Staphylococcus aureus |
For children < 25kg Cloxacillin 200mg/kg/day IV in 4-6 divided doses Step down Cloxacillin 25-50mg/kg/ day PO in 4 divided doses (max. 1gm/day) For children > 25 kg Use adult dosage |
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Duration: 7-10 days If no positive blood culture associated with SSSS, then IV therapy can be stopped following clinical improvement and switch to oral. |