Management of cellulitis in a pediatric emergency department

• Published in: Pediatric emergency care Vol. 23; no. 11; p. 805
• Main Authors: Khangura, Simi, Wallace, Jonathan, Kissoon, Niranjan, Kodeeswaran, Tanuja
• Format: Journal Article
• Language: English
• Published: United States 01.11.2007
• Subjects: Academic Medical Centers; Adjuvants, Pharmaceutic - therapeutic use; Administration, Oral; Adolescent; Anti-Bacterial Agents - therapeutic use; British Columbia - epidemiology; Case-Control Studies; Cefazolin - therapeutic use; Cellulitis - drug therapy; Cellulitis - epidemiology; Cellulitis - microbiology; Cephalexin - therapeutic use; Child; Child, Preschool; Cloxacillin - therapeutic use; Emergency Service, Hospital - statistics & numerical data; Emergency Service, Hospital - utilization; Female; Humans; Infant; Infusions, Intravenous; Male; Patient Admission - statistics & numerical data; Probenecid - therapeutic use; Retrospective Studies; Staphylococcus aureus - isolation & purification; Streptococcus pyogenes - isolation & purification; British Columbia
• DOI: 10.1097/PEC.0b013e31815a032f

(1) To determine antibiotic choices, route of administration, and outcomes of children treated as outpatients with noncomplicated, nonfacial cellulitis at a tertiary care center. (2) To determine the number of visits and time spent in the emergency department (ED) for treatment. A descriptive case-control study. A tertiary care pediatric ED at an academic medical center. Medical records of all otherwise healthy children (aged 1-16 yrs) presenting with noncomplicated, nonfacial cellulitis over a 3-year period (January 1, 2001-December 31, 2003) were reviewed. Data extracted included the following: demographics; clinical presentation; laboratory and microbiology results; management, including choice, dose, and route of antibiotic(s); treatment failures; and time spent in the ED. None. Two hundred sixty-nine patients met the inclusion criteria, and their charts were selected for review. The oral antibiotic most often prescribed was cephalexin (N = 105). Treatment failure occurred in 10 (8.9%) of the cases. The intravenous antibiotic most often prescribed was cefazolin (N = 124; 39 received cefazolin alone, and 85 received cefazolin and probenecid). The cefazolin-only group had 12 (31%) treatment failures, whereas the cefazolin and probenecid group had 7 (8.1%) treatment failures. More time in the ED (521 +/- 287 minutes) and more visits (3.4 +/- 2.8) were seen in the intravenous group as compared with the oral group (time in ED, 164 +/- 139 minutes; visits, 1.4 +/- 1). Noncomplicated, nonfacial cellulitis is most commonly treated using first-generation cephalosporins. Treatment with oral antibiotics was effective and required fewer visits and less time in the ED compared with intravenous treatment. Twice-daily cefazolin and probenecid was associated with less treatment failures and admissions than cefazolin alone and may represent a reasonable alternative for children with nonfacial cellulitis requiring intravenous antibiotics.