Prospective evaluation of the management of moderate to severe cellulitis with parenteral antibiotics at a paediatric day treatment centre.
OBJECTIVE
To assess the clinical outcome of patients with moderate to severe cellulitis managed at a paediatric day treatment centre (DTC).


METHODS
Prospective observational study of all patients (3 months to 18 years) with a presumed diagnosis of moderate to severe cellulitis made in a university-affiliated paediatric emergency department (ED) (September 2003 to September 2005). Patients treated at the DTC were given ceftriaxone or clindamycin.


RESULTS
During the study period, a presumed diagnosis of moderate to severe cellulitis was made in 224 patients in the ED. Ninety-two patients were treated at the DTC (41%). The cellulitis had a median width of 7.0 cm (range: 1.0-50.0 cm) and a median length of 6.5 cm (range: 1.0-40.0 cm). Blood cultures were performed in 95.7%; one was positive for Staphylococcus aureus. After a mean of 2.5 days of intravenous therapy (first injection in the ED and a mean of 1.5 days at the DTC), 73 patients (79.3%) were successfully discharged from the DTC and switched to an oral agent. For these patients no relapse occurred. Nineteen patients (20.7%) required inpatient admission for further therapy. No patient was diagnosed with necrotizing fasciitis in the course of therapy. Seventy-eight satisfaction questionnaires were handed in and revealed very good to excellent parental satisfaction with treatment at the DTC in 94.8%.


CONCLUSIONS
Treatment with parenteral antibiotic at a DTC is a viable alternative to hospitalisation for moderate to severe cellulitis in children.
Gouin
Serge
S
Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada. sergegouin@aol.com
Chevalier
Isabelle
I
Gauthier
Marie
M
Lamarre
Valérie
V
D000284:Administration, Oral; D000293:Adolescent; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002443:Ceftriaxone / Q000008:administration & dosage; D002481:Cellulitis / Q000097:blood / Q000188:drug therapy* / Q000382:microbiology; D002506:Cephalexin / Q000008:administration & dosage; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D002981:Clindamycin / Q000008:administration & dosage; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007263:Infusions, Parenteral; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002981:Clindamycin; D002443:Ceftriaxone; D002506:Cephalexin