Management of cellulitis in a pediatric emergency department.
OBJECTIVE
(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.


METHODS
A descriptive case-control study.


METHODS
A tertiary care pediatric ED at an academic medical center.


METHODS
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.


METHODS
None.


RESULTS
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).


CONCLUSIONS
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.
Khangura
Simi
S
Division of Emergency Medicine, Departments of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Wallace
Jonathan
J
Kissoon
Niranjan
N
Kodeeswaran
Tanuja
T
D000046:Academic Medical Centers; D000277:Adjuvants, Pharmaceutic / Q000627:therapeutic use; D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001955:British Columbia / Q000453:epidemiology; D016022:Case-Control Studies; D002437:Cefazolin / Q000627:therapeutic use; D002481:Cellulitis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D002506:Cephalexin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003023:Cloxacillin / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D011339:Probenecid / Q000627:therapeutic use; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013297:Streptococcus pyogenes / Q000302:isolation & purification
D000277:Adjuvants, Pharmaceutic; D000900:Anti-Bacterial Agents; D002437:Cefazolin; D003023:Cloxacillin; D002506:Cephalexin; D011339:Probenecid