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Antimicrobial therapy for nonpurulent cellulitis in hemodynamically stable children older than 28 days

Antimicrobial therapy for nonpurulent cellulitis in hemodynamically stable children older than 28 days
This algorithm is meant for use with UpToDate content on evaluation and management of suspected S. aureus or streptococcal SSTI in children. Refer to UpToDate content for details, including management of hemodynamically unstable patients, doses of antibiotics, and alternative agents for children who cannot take penicillins and/or cephalosporins.
MRSA: methicillin-resistant S. aureus; SSTI: skin and soft tissue infection; GAS: group A Streptococcus; IV: intravenous; MSSA: methicillin-susceptible S. aureus; TMP-SMX: trimethoprim-sulfamethoxazole.
* The first 1 or 2 doses of parenteral therapy may be provided in an emergency department or "short stay" unit if one is available.
¶ Diameter of lesion includes surrounding erythema.
Δ Tetracycline antibiotics may cause permanent tooth discoloration for children <8 years of age if used repeatedly. However, doxycycline binds less readily to calcium than other tetracycline antibiotics and may be used for ≤21 days in children of all ages.[1]
Cloxacillin is not available in the United States.
Prepared with data from:
  1. American Academy of Pediatrics. Tetracyclines. In: Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32nd ed, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics, Itasca, IL 2021. p.866.
  2. American Academy of Pediatrics. Staphylococcus aureus. In: Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32nd ed, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics, Itasca, IL 2021. p.678.
  3. Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011; 52:e18.
  4. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:147.
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