Proper wound care key to successful treatment of children's skin infections

For children with uncomplicated skin and soft-tissue infections (SSTIs), careful wound care and follow-up may be more important than the initial choice of antibiotic, new findings suggest.

In a study reported online in Pediatrics, all patients showed improvement at 1 week whether they were treated with cephalexin, a traditional antibiotic without activity against methicillin-resistant Staphylococcus aureus (MRSA), or clindamycin, a newer antibiotic with high anti-MRSA activity.

A total of 191 children (aged 6 months to 18 years) with uncomplicated SSTIs not requiring hospitalization were randomly assigned to treatment with cephalexin (40 mg/kg/d) or clindamycin (20 mg/kg/d). Wound cultures were obtained, and MRSA was cultured from 69% of isolates; 19% grew methicillin-susceptible strains. Spontaneous drainage occurred or a drainage procedure was performed in 97% of the patients before antibiotic treatment.

At 48 to 72 hours, 94% of patients treated with cephalexin and 97% of those treated with clindamycin showed improvement or resolution of their infections. By 7 days, complete resolution was seen in 97% of children who received cephalexin and 94% of those who received clindamycin. Children younger than 1 year and those with fever were more prone to complications and more likely to be hospitalized than other patients, regardless of the antibiotic used. At 3 months, 18% of patients had recurrent infection, but the rate did not differ according to treatment given or drug susceptibility.

The key message for clinicians, say the investigators, is that fastidious wound care of appropriately drained, uncomplicated SSTIs and close follow-up, especially in younger children and in those with fever, “are likely more important than initial antibiotic choice.”

Chen AE, Carroll KC, Diener-West M, et al. Randomized controlled trial of cephalexin versus clindamycin for uncomplicated pediatric skin infections. Pediatrics. 2011. Epub ahead of print.