Inpatient Pathway for the Evaluation/Treatment of
the Child with Suspected Cellulitis/Abscess
Consideration for Subspecialty Consultation
General Surgery Breast
Perianal
Perineal
Pilonidal
Large, complex
ENT Neck
Ophtho/ENT Orbital
Periorbital
Orthopedics Septic arthritis
Tenosynovitis
Osteomyelitis
Dental/OMFS Facial cellulitis due to dental infection
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Daily Re-evaluation
Vital Signs, Fever Curve
Clinical Exam
Pain
PO Intake
Culture Results
Laboratory Testing
Analgesia/Supportive Care
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Clinical Improvement
No/Inadequate Clinical Improvement
  • Decreased: induration, erythema, size, pain, receding from outline
    • Improving fever curve
    • Tolerating PO Intake
  • Increased or no change: induration, erythema, size, pain after 48 hours
    • Continued fever
    • New fluctuance
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  • Review Antibiotics/Culture Sensitivities
  • Tailor if culture sensitivities are available
  • Not necessary to wait for sensitivities if adequate clinical improvement
  • Always use narrowest spectrum available
  • Conversion to PO antibiotics prior to discharge is not necessary
  • Review Antibiotics/Culture Sensitivities
    • Tailor if culture sensitivities are available
  • Concern for New Fluctuance/Evolving Abscess
    • Obtain ultrasound
    • Consult General Surgery if drainable collection
    • In anticipation of procedure, place NPO orders and a sedation consult
  • No Improvement after 48 Hours
    • Consider empiric antibiotic change
    • Consult ID as needed
  • Rapid Progression, Toxicity
    • ID Consult
  • ED Severe Sepsis Pathway
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Daily Re-evaluation
until Adequate Improvement
  • Discharge Criteria
  • Clinical improvement on empiric antibiotics or known sensitivities
  • Improving fever curve
  • Tolerating PO
  • Pain control
  • Antibiotic course for 5 days after clinical improvement noted
  • PMD follow-up assured in 72 hours
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Posted: March 2015
Revised: August 2017, November 2017
Authors: L. McAndrew, MD; S. Helman, MSN; C. Christian, MD; L. Utidjian, MD; J. Lavelle, MD;
N. Washington, MD; K. Henry, MD; S. Coffin, MD; P. Mattei, MD
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References