Emergency Department and Inpatient Clinical Pathway for
Evaluation/Treatment of Children with Suspected Cellulitis/Abscess
Team Assessment
Cellulitis
(Non-purulent)
(Non-purulent)
Concern for Underlying Abscess
(Purulent)
(Purulent)
Low concern for underlying purulence, abscess
- Induration, edema w/o clear fluctuance
- No history of purulent drainage
- Fluctuance, swelling
- History, presence of purulent drainage
Ultrasound
Bedside/Radiology
Bedside/Radiology
Drainable
Collection
Collection
No Drainable
Collection
Collection
-
Discharge
- Antibiotic Considerations
- Wound Care
- Follow-up PCP 48-72 hrs
Admit
Daily Re-evaluation
Clinical Improvement
No/Inadequate Clinical Improvement
After 48 hrs
After 48 hrs
- Decreased induration, erythema, size, pain, receding from outline
- Improving fever curve
- Tolerating PO
- No change or increased induration, erythema, size, pain
- Continued fever
-
If concern for new fluctuance/evolving abscess:
- Obtain ultrasound
- Consult ID as needed
- Consult General Surgery if suspected drainable collection
- In anticipation of procedure, place NPO orders and Sedation Consult
-
Rapid progression or concern for necrotizing fasciitis
- Consult General Surgery
- Consult ID
- Consider Sepsis Pathway
Review Antibiotics and Culture Sensitivities
- Tailor if culture sensitivities are available
- Not necessary to wait for sensitivities if
adequate improvement - Not necessary to convert to PO antibiotics
prior to discharge
-
Discharge
- Antibiotic Considerations
- Wound Care
- Pain Control
- Follow up PCP 48-72 hrs if needed
Review Antibiotics and Culture Sensitivities
Tailor if culture sensitivities are available
Daily re-evaluation until adequate improvement
Posted: June 2024
Editors: Clinical Pathways Team
Editors: Clinical Pathways Team
References
- Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections
- Clinical trial: Comparative Effectiveness of Cephalexin Plus Trimethoprim-sulfamethoxazole Versus Cephalexin Alone for Treatment of Uncomplicated Cellulitis: a Randomized Controlled Trial
- Comparison of Short-course (5 Days) and Standard (10 Days) Treatment for Uncomplicated Cellulitis
- Randomized Controlled Trial of Cephalexin Versus Clindamycin for Uncomplicated Pediatric Skin Infections
- Emergency Ultrasound-assisted Examination of Skin and Soft Tissue Infections in the Pediatric Emergency Department
- Blood Cultures in the Evaluation of Uncomplicated Skin and Soft Tissue Infections
- Routine Packing of Simple Cutaneous Abscesses is Painful and Probably Unnecessary
- Systemic Antibiotics for the Treatment of Skin and Soft Tissue Abscesses: A Systematic Review and Meta-Analysis