BNF for Children 2011-2012

BNFC 2011–2012 5.1 Antibacterial drugs 253SkinImpetigo: small areas of skin infectedSeek local microbiology advice before using topical treatment in hospital.Topical fusidic acidSuggested duration of treatment 7 days is usually adequate (max. 10 days)Alternative if meticillin-resistant Staphylococcus aureus, topical mupirocinSuggested duration of treatment 7 days is usually adequate (max. 10 days)Impetigo: widespread infectionOral flucloxacillinIf streptococci suspected in severe infection, add phenoxymethylpenicillin.Suggested duration of treatment 7 daysIf penicillin-allergic, oral clarithromycin 1Suggested duration of treatment 7 daysErysipelasPhenoxymethylpenicillin or benzylpenicillinIf staphylococci suspected, replace phenoxymethylpenicillin or benzylpenicillin with flucloxacillin.Suggested duration of treatment at least 7 daysIf penicillin-allergic, clindamycin or clarithromycin 1Suggested duration of treatment at least 7 daysCellulitis: mild or moderateFlucloxacillinIf streptococcal infection confirmed, replace flucloxacillin with phenoxymethylpenicillin or benzylpenicillin.If Gram-negative bacteria or anaerobes suspected (e.g. facial infection, orbital infection, or infection causedby animal or human bites), use broad-spectrum antibacterialsIf penicillin-allergic, clindamycin or clarithromycin 1If Gram-negative bacteria or anaerobes suspected, use broad-spectrum antibacterialsCellulitis: severeBenzylpenicillin + flucloxacillinIf oral treatment required, replace benzylpenicillin with phenoxymethylpenicillin.If streptococcal infection confirmed, discontinue flucloxacillin.If Gram-negative bacteria or anaerobes suspected, use broad-spectrum antibacterialsIf penicillin-allergic, clindamycin or clarithromycin 1If Gram-negative bacteria or anaerobes suspected, use broad-spectrum antibacterialsStaphylococcal scalded skin syndromeFlucloxacillinSuggested duration of treatment 7–10 daysIf penicillin-allergic, clarithromycinSuggested duration of treatment 7–10 daysAnimal and human bitesCleanse wound thoroughly. For tetanus-prone wound, give human tetanus immunoglobulin (with a tetanuscontainingvaccine if necessary, according to immunisation history and risk of infection), see under TetanusVaccines, section 14.4. Consider rabies prophylaxis (section 14.4) for bites from animals in endemic countries;assess risk of blood-borne viruses.Co-amoxiclavIf penicillin-allergic, clindamycinAcneSee section 13.6.Paronychia or ‘septic spots’ in neonateFlucloxacillinIf systemically unwell, add an aminoglycosideSurgical wound infectionFlucloxacillin or co-amoxiclav1. Where clarithromycin is suggested azithromycin or erythromycin may be used5 Infections