The Center For Disease Dynamics, Economics & Policy

Skin & Soft Tissue Infections (Including Impetigo, Cellulitis, Abscesses)

Clinical definition:

Bacterial infections of skin and underlying soft tissue. Common bacterial pathogens include S. aureus and Group A Streptococcus species. Anaerobes may play a role in specific regions of the body including the perineum.

 

Neonate, Infant, Child & Adolescent

Preferred antibiotic choice
Drug Formulation Dosage Duration
Cloxacillin (IV) Cloxacillin- Powder for injection: 500 mg (as sodium salt) in vial o   First week of life (7 days or less): 50 mg/kg/dose 12 hourly

o   8-28 days: 50 mg/kg/dose 8 hourly

o   Older than 28 days: 25-50 mg/kg/dose 6 hourly, maximum dose 2 g 6 hourly

5 – 7 days
If Cloxacillin (IV) is not available, use Cefazolin (IV). Cefazolin- Powder for injection: 1 g (as sodium salt) in vial  

o   First week of life (7 days or less): 50 mg/kg/dose 12 hourly

o   8 days & older: 50 mg/kg/dose 8 hourly, maximum dose 4 g 8 hourly

For infants, children, and adolescents, switch to oral therapy when tolerated (Neonates should complete IV therapy):
Flucloxacillin (PO) Capsules: 500 mg; 1 g (as sodium salt) 25 mg/kg/dose 6 hourly, maximum dose 500 mg 6 hourly 5 – 7 days

(Total treatment duration including IV therapy.)

Alternative antibiotic choice for infants and children unable to swallow Flucloxacillin capsules:
Cefalexin (PO) Powder for reconstitution with water: 125 mg/5 mL; 250 mg/5 mL; Solid oral dosage form: 250 mg (as monohydrate) 25 mg/kg/dose 6 hourly, maximum dose 1 g 6 hourly 5 – 7 days
In case of confirmed drug allergy or medical contraindication:
Clindamycin (IV/PO) Oral liquid: 75 mg/5 mL (as palmitate). Capsule: 150 mg (as hydrochloride). Injection: 150 mg (as phosphate)/mL 6 mg/kg/dose 6 hourly, maximum dose 600 mg 8 hourly (IV) or 450 mg 6 hourly (PO) 5 – 7 days

 

Principles of Stewardship:

  • If the abscess can be incised and drained, withhold antibiotics for standard, uncomplicated abscess in an otherwise well person.
  • If IV antibiotic therapy is indicated, review patient progress daily to consider switch from IV to oral therapy.

Notes:

  • For patients with suspected animal bite, assess for rabies risk and manage accordingly, and administer a tetanus booster dose if indicated.
  • If necrotizing fasciitis is suspected (especially if in perineal area), use ceftriaxone plus metronidazole plus clindamycin or, alternatively, amoxicillin/clavulanic acid plus clindamycin (clindamycin included to suppress toxin production), and obtain urgent expert advice regarding surgical management.