The treatment of cellulitis is the administration of systemic antibiotic therapy. Although most patients respond rapidly to oral antistaphylococcal agents, the clinician must identify those individuals who require broad-spectrum or intravenously administered drugs ( Fig 117-3).

FIG. 117-3. Approach to the child with cellulitis.

Obviously, signs of sepsis are indicative of hematogenous dissemination and demand treatment as an inpatient. Additionally, children under 6 months of age and those with impaired immunity are unable to contain local bacterial infections and will benefit from intravenous therapy.

Among otherwise healthy children over 6 months of age, only those who are clinically ill-appearing, or in whom bacteremic disease is suspected, need to be admitted to the hospital. Prior to the advent of the Hemophilus vaccine, physicians could identify patients at risk for invasive H. influenzae disease fairly reliably on the basis of anatomic location, presence of fever, and a WBC count greater than 15,000/pL. Although the incidence of this disease has dropped considerably, it is important to remember that young infants are still at some risk of being infected with this organism.

The usual therapy for patients discharged from the emergency department is an antistaphylococcal antibiotic, such as dicloxacillin or cephalexin. Broad-spectrum therapy is recommended presumptively for patients who are immunocompromised or suspected to have bacteremia, pending a definitive isolate (T§b]e.,..11Zz9).

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