Cellulitis/Abscess Clinical Pathway — Emergency Department

Analgesia/Sedation
Incision and Drainage Procedure
- Provider Preparation
- Indications for I&D
- Step by Step Procedure
- US guidance, Indications for culture

Admit EDECU
vs. Inpatient

Discharge Instructions

Treatment

Review Admission Considerations

Discharge

Admit EDECU vs. Inpatient

Antibiotics not recommended if:

Single lesion < 2 cm and I&D successful
No overlying cellulitis
Healthy patient
No significant systemic symptoms

PO cephalexin
PO clindamycin if:
- Cephalosporin allergy
- Failed cephalexin
- Presence of any MRSA risk factors such as:
  - History of prior MRSA infection or carriage
  - Known close/household contact with MRSA
  - Use of IV drugs
Alternate: Bactrim

IV cefazolin
IV clindamycin if:
- Cephalosporin allergy
- Failed cephalexin
- Presence of any MRSA risk factors such as:
  - History of prior MRSA infection or carriage
  - Known close/household contact with MRSA
  - Use of IV drugs
IV vancomycin if known or suspected clindamycin resistance

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: January 2023
Authors: L. McAndrew, MD; A. Chen, MD; Y. Tay, MD; S. Swami, MD; C. Kerman, MD; K. Chiotos, MD

References

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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.

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

References

Emergency Department Clinical Pathway for Evaluation/Treatmentof Children with Suspected Cellulitis/Abscess

References

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