ED Pathway for the Evaluation/Treatment of the
Child with Suspected Cellulitis/Abscess
Concern for Necrotizing Fasciitis
Immediate Surgical Consult
ED Severe Sepsis Pathway
Cellulitis
(Non-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
Treatment
Ultrasound
Bedside/Radiology
Drainage Procedure
Drainable
Collection
No Drainable
Collection
Admit EDECU
vs. Inpatient
  • IV Cefazolin
  • IV Clindamycin if:
    • Cephalosporin allergy
    • Failed Cephalexin
  • Draw circle around cellulitis
  • Consider taking photo using Haiku
  • PO Cephalexin
  • PO Clindamycin if initial treatment failure
  • Follow-up 48 hours
Treatment
Discharge
Admit EDECU vs. Inpatient
*Antibiotics not recommended if:
  • I&D successful
  • No overlying cellulitis
  • Healthy patient
  • No significant systemic symptoms
  • *PO Clindamycin
    as clinically indicated
  • Alternate: Bactrim
  • IV Clindamycin
  • IV Vancomycin if:
    • Known/presumed clindamycin resistance
  • Draw circle around abscess
  • Consider taking photo using Haiku
Discharge Instructions, Wound Care, Follow-up
Consideration for Subspecialty Consultation
General Surgery Breast
Perianal
Perineal
Pilonidal
Large, complex
ENT Neck
Optho/ENT Orbital
Periorbital
Orthopedics Septic arthritis
Tenosynovitis
Osteomyelitis
Dental/OMFS Facial cellulitis due to dental infection
Admission Considerations: EDECU vs Inpatient
  • Inpatient Criteria
  • Systemic systems
    • Concern for SIRS
    • Fever alone does not necessitate admission
  • Concern for subsequent, future I&D need
  • Concern for deeper infection
    • Need for subspecialty consultation
  • Review exclusion criteria
  • EDECU Criteria
  • Inpatient admission criteria not met
  • Likely to improve within 24 hours
  • Failed initial treatment w/48 hours appropriate antibiotics
  • Rapidly expanding lesions or large lesions, but unlikely to need subsequent or future I&D
  • Significant pain
  • Unable to tolerate oral antibiotics
  • Age < 6 months (who do not meet inpatient criteria)
  • Review exclusion criteria
Posted: March 2015
Revised: August 2017, May 2018, January 2019
Authors: L. McAndrew, MD; A. Chen, MD; Y. Tay, MD; S. Swami, MD; C. Kerman, MD