Outpatient management of moderate cellulitis in children using high-dose oral cephalexin

Abstract

Objectives: To evaluate the effectiveness of a high-dose (HD) oral cephalexin treatment guideline for children with moderate cellulitis treated as outpatients.

Methods: In this retrospective cohort study, we included children who presented to the emergency department (ED) with moderate cellulitis and treated according to the institution's HD oral cephalexin guideline over a 2-year period. All children had standardized follow-up at a medical day hospital (MDH). Treatment was considered effective in the absence of treatment failure, defined as admission, switch to IV treatment or ED visit within 2 weeks of discharge from the MDH. Safety was ascertained by recording adverse events and severe complications at follow-up.

Results: A total of 123 children were treated as outlined in the guideline, including 117 treated with HD oral cephalexin. The success rate was 89.7% (105/117). Among 12 (10.3%) children who had treatment failure, 10 (8.5%) required admission, 1 (0.9%) received IV antibiotics at the MDH and 1 (0.9%) had a return visit to the ED without admission. No severe complications were reported; four abscesses required drainage and one patient had a rash. The mean number of visits per child at the MDH was 1.6 (SD 1.0).

Conclusions: With a success rate of 89.7%, HD oral cephalexin seems effective and safe for the treatment of children with moderate cellulitis. Its use potentially reduces hospitalization rates for this condition and decreases the need for IV insertion.

Graphical abstract

Figure 1.

Patients consulting for cellulitis between January 1, 2014 and January 1, 2016. Abbreviations: ATB antibiotic; ED, Emergency Department; HD, High Dose; IV, intravenous; MDH, Medical Day Hospital; n, number; PO, oral. *IV ATB in the ED for 23 patients: 16 treated with previous IV ceftriaxone guideline (6 later admitted), 1 treated with IV cefazolin, and 6 with IV cefotaxime followed by HD oral cephalexin guideline (0 admitted). ^ΩOther PO ATB prescribed (outside of pre-written order) in 30 patients: 20 treated with standard PO doses of cephalexin, 1 PO cefadroxil, 1 PO azithromycin, 6 PO amoxicillin clavulanate, and 1 PO Trimethoprim/sulfamethoxazole.