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Remember to check allergy status

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Paediatric Treatment - Skin & Soft Tissue Infections

For MRSA infection see PHE Quick Reference Guide

Scabies

NICE-CKS

Treat whole body from ear/chin downwards and under nails. If under 2/elderly, also face/scalp 2
Treat all home & sexual contacts within 24h 1 C.

Medicine Calendar

First line permethrin 3 A+

5% cream

2 applications 1 week apart1 C

If allergic: malathion 3 C

0.5% aqueous liquid

2 applications 1 week apart1 C

Impetigo

Sources: NICE-CKS

For extensive, severe, or bullous impetigo, use oral antibiotics 1 C.
Reserve topical antibiotics for very localised lesions to reduce the risk of resistance 1,5 C,4 B+.
Reserve mupirocin for MRSA 1 C.

Medicine Calendar

flucloxacillin 2 C

See BNFc

7 days

If penicillin allergic:
clarithromycin 2 C

See BNFc

7 days

Leg ulcer

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NICE-CKS
PHE

Ulcers are always colonized. Antibiotics do not improve healing unless active infection 1 A+.
Active infection: if cellulitis/increased pain/pyrexia/purulent exudate/odour 2 C. If active infection, send pre-treatment swab 3 C. Review antibiotics after culture results.

Medicine Calendar

For paediatric doses of flucloxacillin and clarithromycin for this indication, please see Cellulitis

Bites (human, cat or dog)

Sources: NICE-CKS

Thorough irrigation is important.
Assess risk of tetanus, rabies, HIV, hepatitis B&C1C
Antibiotic prophylaxis is advised 2B-

Give prophylaxis if cat bite/puncture wound2; bite to hand, foot, face, joint, tendon, ligament; immunocompromised/diabetic/asplenic/cirrhotic/presence of prosthetic valve or prosthetic joint.

Medicine Calendar

Prophylaxis or treatment: co-amoxiclav AND review at 24 & 48hrs 6 C

See BNFc

7 days 3,4,5 C

If penicillin allergic:
metronidazole PLUS clarithromycin added (human bite): AND review at 24 & 48hrs 6 C

See BNFc for metronidazole and clarithroymcin dosing

7 days 3,4,5 C

Cellulitis

Sources: NICE-CKS

Class I: If patient afebrile and healthy other than cellulitis, use oral flucloxacillin alone 1,2,5 C
Class II: If febrile and ill, or comorbidity, admit for IV treatment or use OPAT (if available)
Class III: If toxic appearance - admit.1 If river or sea water exposure, discuss with specialist.

Medicine Calendar

flucloxacillin 1,2,3,5 C

See BNFc

7 days. If slow response continue for a further 7 days1 C

If penicillin allergic: clarithromycin 1,2,3,5 C

See BNFc

7 days. If slow response continue for a further 7 days1 C

If facial: co-amoxiclav 4 C

See BNFc

7 days. If slow response continue for a further 7 days1 C

Eczema

Sources: NICE-CKS

If no visible signs of infection, use of antibiotics (alone or with steroids) encourages resistance and does not improve healing 1 B. In eczema with visible signs of infection, use treatment as in impetigo 2 C

Medicine Calendar

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The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).