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.