[Managing children skin and soft tissue infections].
The skin infections are common in pediatrics, ranging from furonculosis or impetigo to the severe forms of necrotizing dermohypodermitis. The general antibiotic treatments are not always indicated but when they are, they must take into account the resistance of two main species of bacteria (Staphylococcus aureus and Streptococcus pyogenes), the pharmacokinetics-pharmacodynamic parameters and the severity and type of infection. Two situations should be treated by topical treatements: limited impetigo and furonculosis. The two topical antibiotics used preferentially are mupirocine and fucidic acid. Soon, a third topical antibiotic, reptamuline will complete these. For uncomplicated superficial skin infections justifying an oral antibiotic, amoxicillin-clavulanate offers the best guarantee of efficiency. Poor pharmacodynamic-pharmacokinetic must lead to not prescribe oral M penicillins. In case of allergy, a first-generation cephalosporin, a macrolide (if the susceptibility of the strain was checked) or pristinamycine (after 6 years of age) are acceptable alternatives. For dermohypodermitis bacterial antibiotic of choice remains amoxicillin-clavulanate through IV route, to be active against S. pyogenes but also S. aureus and anaerobic bacteria. The IV route is maintained until regression general signs and a relay orally by the same drug is then possible. For toxinic syndromes and necrozing fascitis clindamycin should be added to a beta-lactam because of its action on protein synthesis in particular reducing the toxins production.
Moulin
F
F
Urgences pédiatriques, Hôpital Saint Vincent de Paul, 82 av Denfert-Rochereau, 75014 Paris, France. Florence.moulin@svp.aphp.fr
Quinet
B
B
Raymond
J
J
Gillet
Y
Y
Cohen
R
R
D000284:Administration, Oral; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002481:Cellulitis / Q000188:drug therapy; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D024881:Drug Resistance, Bacterial; D019115:Fasciitis, Necrotizing / Q000188:drug therapy; D005667:Furunculosis / Q000188:drug therapy; D005672:Fusidic Acid / Q000627:therapeutic use; D006801:Humans; D007169:Impetigo / Q000188:drug therapy; D007275:Injections, Intravenous; D018942:Macrolides / Q000627:therapeutic use; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D016712:Mupirocin / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D025762:Pristinamycin / Q000627:therapeutic use; D017192:Skin Diseases, Bacterial / Q000188:drug therapy*; D018461:Soft Tissue Infections / Q000188:drug therapy*; D013206:Staphylococcal Scalded Skin Syndrome / Q000188:drug therapy; D013207:Staphylococcal Skin Infections / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000187:drug effects; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy; D013290:Streptococcal Infections / Q000188:drug therapy; D013297:Streptococcus pyogenes / Q000187:drug effects
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D018942:Macrolides; D010406:Penicillins; D025762:Pristinamycin; D005672:Fusidic Acid; D019980:Amoxicillin-Potassium Clavulanate Combination; D016712:Mupirocin