UC CLINICAL PRACTICE GUIDELINE FINAL 7.25.19 SKIN AND SOFT TISSUE (SSTI) (AKA ABSCESS/) Suspected skin/soft tissue infection in children ≥ 2 months old

INCLUSION CRITERIA

• A confined purulent collection of fluid with localized pain, redness, swelling & warmth CELLULITIS ABSCESS • Fluctuant, actively draining, fluid collection, or purulent collection confirmed on US • Redness of Skin with Infection

EXCLUSION CRITERIA* INCLUSION• Hospital-acquired, CRITERIA surgical site & device- Non-Purulent associated • Presumed SMALL SMALL MEDIUM to • Immunodeficiency/Immunocompromised < 1cm <1cm with LARGE • Pressure ulcers No Cellulitis cellulitis ≥ 1cm • • Ill appearing patient • Age < 2 mo. • Rapidly progressing cellulitis Incision and • Abscess > 5cm Cephalexin LMX and LMX and Drainage *The following soft tissue infections are 15mg/kg/dose TID Incision and Incision and Consider Pain/ excluded from the Guideline. Consider x 5 days Drainage as Drainage as Sedation obtaining a subspecialist consult. MAX Dose = needed needed Management 500mg TID • Breast abscess • Purulent Neck • Deep Extremity Lymphadenitis Infection • • Deep Puncture • Orbital/periorbital abscess D/C home wound of hand/ D/C home and Send Wound • Perineal abscess No 1 fingers/feet follow-up with Culture • Perianal/perirectal Follow-up with • Facial cellulitis PMD in 2-3 days abscess PMD in 2-3 days • Groin • Large or • Pilonidal Routine complex • Solitary dental Labs are abscess abscess NOT • Bite related • Severe rapidly cellulitis progressive necessary Cellulitis

If the abscess is ≥ 1cm and ≤ 5cm and 2 dependent on patient’s age, it is at the Empiric Treatment for Abscess discretion of the physician to drain the First SSTI: Bactrim (TMP/SMX): 5mg TMP/kg/dose abscess in the UC. However in such Empiric 2 BIDX 7 days cases, it is strongly recommended to Treatment Max dose is 320mg TMP (or 2 double provide additional sedation. or strength tablets BID) TMP/SMX OR (Bactrim) Clindamycin 10mg/kg/dose TID x 7 days MAX dose = 600mg TID

Discharge Home Recurrent: Clindamycin 10mg/kg/dose Follow up with PMD TID x 7 days MAX dose = 600mg TID in 3 days

Transfer Criteria:

• Failed oral antibiotics (worse after 48hrs, 1 Wound Cultures are followed by emesis or inability to tolerate oral the Transfer Center. If the culture is , adverse reaction) not sensitive to the prescribed • Rapidly progressing lesion or significant/ antibiotic, the Call Back Center unrelieved pain notifies the ED physician to assess and determine the need to change antibiotic.

Developed through the efforts of Children's Healthcare of Atlanta and physicians on Children’s medical staff in the interest of advancing pediatric healthcare. This is a general guideline and does not represent a professional care standard governing providers' obligation to patients. Ultimately the patient’s physician must determine the most appropriate care. © 2019 Children’s Healthcare of Atlanta, Inc.