Cellulitis/Abscess, Suspected — Treatment Failure — Clinical Pathway: Emergency

Treatment Failure

After 48 hours of appropriate treatment: Increased: induration, erythema

Pain, size
New fluctuance
New, persistent fever

Review Initial Treatment

Past culture if available
Consider antibiotic change
Consider ultrasound bedside/radiology

Initial Diagnosis Cellulitis
(Non-purulent)

Initial Diagnosis
Suspected or Definite Abscess
(Purulent)

Assure no concern for underlying:
- Bone, joint or muscle infection
- Foreign body
Evaluate need for:
- Change in current antibiotics
- Need for IV antibiotics

I&D if drainable collection
Evaluate need for:
- Addition of antibiotics
- Change in current antibiotics
- Need for IV antibiotics

Admission Considerations

Systemic symptoms (significant fever, SIRS)
Rapidly expanding lesions, large lesions
Age < 6 months
Concern for inadequate drainage of large abscess
Abscess location that requires subspecialty consultation
Unable to tolerate PO antibiotics
Significant pain
Failed initial treatment w/48 hours appropriate antibiotics
Follow-up concerns
Review exclusion criteria

Pathogen Susceptibility at CHOP

	% Organism Susceptibility
	*S. pyogenes*	MSSA	MRSA
Cefazolin, cephalexin	100	100	0
Clindamycin	Variable	82	89
TMP-SMX	Variable, Not Recommended	100	89
Doxycycline	N/A	92	98
Vancomycin	100	100	100

Finding the CHOP Antibiogram

©2024 by Children's Hospital of Philadelphia, all rights reserved.
Use of this site is subject to the Terms of Use.

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.