Cellulitis/Abscess Clinical Pathway — Emergency Department and Inpatient

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
Last Revised: October 2024

Authors:
- L. McAndrew, MD;
- A. Chen, MD;;
- Y. Tay, MD;
- S. Swami, MD;
- C. Kerman, MD;
- K. Chiotos, MD;
- L. Utidjian, MD;
- J. Lavelle, MD;
- N. Washington, MD;
- K. Henry, MD;
- P. Mattei, MD;
- S. Helman, MSN;
- L. Rodriguez, PharmD

Editors: Clinical Pathways Team

References

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

Emergency Department and Inpatient Clinical Pathway for Evaluation/Treatment of Children with Suspected Cellulitis/Abscess

References

Emergency Department and Inpatient Clinical Pathway for
Evaluation/Treatment of Children with Suspected Cellulitis/Abscess