Oral Antibiotic Treatment for Staphylococcal Scalded Skin Syndrome (SSSS) in Children

Initial Treatment and Transition to Oral Therapy

The Infectious Diseases Society of America recommends dicloxacillin at 25-50 mg/kg/day divided into 4 doses for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) in children with SSSS 1, 2
Cephalexin is also recommended at 25-50 mg/kg/day divided into 3-4 doses for the treatment of MSSA in children with SSSS 1, 2
Clindamycin can be used as an alternative oral option at 20-30 mg/kg/day divided into 3 doses if the patient has a penicillin allergy or if local MSSA strains show susceptibility 1, 2

For communities with high MRSA prevalence or if the patient is critically ill and not improving on standard therapy, clindamycin can be used at 30-40 mg/kg/day divided into 3 doses (if local resistance <10%) 3, 4
Linezolid can also be used for the treatment of MRSA at 10 mg/kg every 12 hours for children <12 years; 600 mg twice daily for children ≥12 years 3, 4
TMP-SMX can be used at 8-12 mg/kg/day (based on trimethoprim component) divided into 2 doses for the treatment of MRSA 1, 2

The duration of therapy is typically 7-10 days total (IV plus oral), but this depends on clinical response 3
For patients with non-immediate hypersensitivity reactions to penicillin, cephalexin is an appropriate alternative 1, 2
Tetracyclines (doxycycline, minocycline) should not be used in children <8 years of age 1, 3, 4