Does this Child with Cellulitis Need IV Antibiotics?
MarkNeuman, MD, MPH, Assistant Editor, Pediatrics
Skin and soft tissue infections account for a large number of outpatient visits and
hospitalizations in children. Although guidelines exist to help clinicians determine
the need for IV antibiotic therapy for children with cellulitis, most recommendations
are based upon expert opinion rather than from scientific evidence. As a result, pediatricians
and emergency physicians often struggle with the decision of whether the child with
cellulitis requires hospitalization and IV antibiotic therapy.
This week, we are early releasing a study (10.1542/peds.2018-1420) by Ibrahim et al. which develops and validates a clinical score to determine the
need for IV antibiotic therapy among children with cellulitis. The score utilizes
five commonly assessed clinical features including the size of the affected area,
presence of systemic features, eye involvement, and degree of swelling and tenderness.
Although I’ve given you the “skinny”, you’ll need to ready the study yourself to learn
how these simple clinical findings can be used to determine the need for IV antibiotics
in children with cellulitis. Given the heightened public concern surrounding this
topic, pediatricians are likely to face questions from families regarding whether
their child requires hospitalization for cellulitis, or whether oral antibiotics would
suffice. This article will provide useful information to inform discussions around
whether the use of this novel cellulitis score is ready for prime-time, and how to
help provide anticipatory guidance to your patients and their families with skin infections.