Some Pediatric Cellulitis Successfully Treated at Home, Study Suggests

SAN DIEGO, CA—Children with uncomplicated cellulitis may be safely treated at home, as they are unlikely to have bacteremia, Laila F. Ibrahim, MBBChBAO, from the Royal Children’s Hospital @ Home Department in Parkville, Australia, reported at IDWeek 2015.

Intravenous (IV) antibiotics are commonly administered for adults with cellulitis as outpatients; however, most children are admitted to the hospital. The study team put into effect direct admission from the Emergency Department to the hospital-in-the-home program for children with moderate-to-severe cellulitis for IV treatment with ceftriaxone at home.

The prospective study compared inpatient (n=38) vs. home care (n=41) of cellulitis. All patients aged 6 months to 18 years attending the Emergency Department with uncomplicated moderate/severe cellulitis from April 2014 to December 2015 were included. Blood cultures, nasal swabs, skin swabs (if clinically indicated) and prospective data of clinical features and outcomes were collected.

“The primary outcome was treatment failure defined as any change of initial empiric antibiotics within two days from commencement due to inadequate clinical improvement or adverse events,” she reported.

Excluded were complicated cellulitis, defined as dog bite, orbital cellulitis, abscess not drained, penetrating injury, suspected fasciitis, toxicity, and foreign body, as were any comorbidities, such as immunocompromised, varicella, any condition needing different antibiotic treatment.

Median age was 4.3 years in those treated at home and 4.7 years for those hospitalized. Skin swabs were positive in 49% of children treated at home vs. 55% of those treated in the hospital, with the majority having MSSA, 20% vs. 16%, respectively.

Treatment failure rate in the group treated at home—two patients, or 4.8%—was no worse than those treated in the hospital, 7 patients, or 17.9%. Two patients were transferred to the hospital from the home during treatment and one treated in the hospital was readmitted after the end of treatment.

Study data showed that Staphylococcus aureus isolates were sensitive to ceftriaxone; however, “none of the nasal swab results had any influence in clinical management,” she reported. “Although one nasal swab cultured MRSA, the child also had a MRSA-positive skin swab.”

Parental preference of treatment location indicated 60% selected the home; 15%, the hospital (all had children who received treatment in the hospital); and 24% were “equally happy with either.”

“This study was not designed to investigate the effects of the use of a broad spectrum antibiotic on healthy children in an outpatient setting,” they noted. “A further study is planned to investigate the effects of ceftriaxone on children’s gut microbiota and longer term clinical effects.”

Finally, “to remove bias and provide evidence to support the safety and efficacy of home treatment of moderate/severe cellulitis with ceftriaxone, a randomized controlled trial is proposed.”