Initial management of purulent/fluctuant SSTI in children older than 28 days

SSTI: skin and soft tissue infection; I & D: incision and drainage; IV: intravenous; MRSA: methicillin-resistant S. aureus; MSSA: methicillin-susceptible S. aureus; TMP-SMX: trimethoprim-sulfamethoxazole.
* Children with cardiac conditions predisposing to adverse outcomes from infectious endocarditis (eg, unrepaired cyanotic congenital heart disease, repaired congenital heart defects with prosthetic defects, etc) should receive prophylactic antibiotics before I & D. Refer to UpToDate content on antimicrobial prophylaxis for bacterial endocarditis for details.
¶ When the etiologic agent and susceptibility are known, antimicrobial therapy can be narrowed as indicated. Refer to UpToDate content on evaluation and management of suspected S. aureus and streptococcal SSTI in children for details.
Δ The first one or two doses of parenteral therapy may be provided in an emergency department observation or "short stay" unit if one is available.
◊ Diameter of lesion includes surrounding erythema/cellulitis.
§ We consider the local prevalence of MRSA to be high if ≥10 to 15% of S. aureus isolates are MRSA. Other experts may use a different threshold.
¥ Tetracycline antibiotics may cause permanent tooth discoloration for children <8 years 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.