Management of Recurrent Staph Skin Infections in Children

Assessment and Diagnosis

The American Academy of Pediatrics recommends assessing the extent, location, and characteristics of the rash, as well as checking for abscess formation requiring drainage, in a child with a suspected staph skin infection 1
Documenting the appearance of the rash (purulent vs. non-purulent) is crucial in determining the appropriate treatment, according to the Infectious Diseases Society of America 3
Obtaining previous culture results, including antibiotic susceptibilities, is essential in guiding therapy, as recommended by the Clinical Infectious Diseases society 4
Assessing for lymphadenopathy or signs of systemic infection is vital in determining the severity of the infection, according to the Pediatric Infectious Diseases society 5
Evaluating the child for underlying medical conditions or immunodeficiency is crucial in determining the appropriate treatment, as recommended by the American Academy of Pediatrics 1

The Infectious Diseases Society of America recommends clindamycin as the first-line therapy for recurrent staph skin infections in children, at a dose of 10-13 mg/kg/dose every 8 hours, with a duration of 7-10 days based on clinical response 1, 2, 3, 7
Obtaining culture before starting antibiotics is recommended to guide therapy if initial treatment fails, according to the Clinical Infectious Diseases society 4
If MRSA is suspected, clindamycin remains appropriate if local resistance rates are low (<10%), as recommended by the Infectious Diseases Society of America 2, 8
Alternative options for MRSA treatment include trimethoprim-sulfamethoxazole (TMP-SMX) combined with amoxicillin, according to the Pediatric Infectious Diseases society 6, 4

Implementing a 5-day decolonization regimen with intranasal mupirocin, daily chlorhexidine baths, and dilute bleach baths can help reduce the risk of recurrence, as recommended by the American Academy of Pediatrics 1, 6
Maintaining good hand hygiene, keeping draining wounds covered, and avoiding sharing personal items can help prevent the spread of infection, according to the Infectious Diseases Society of America 6
Evaluating family members for potential colonization or active infection is crucial in preventing household transmission, as recommended by the Clinical Infectious Diseases society 6

Scheduling follow-up within 48-72 hours to assess treatment response is recommended, according to the Pediatric Infectious Diseases society 3
Considering infectious disease consultation if infection fails to respond to appropriate therapy is crucial, as recommended by the American Academy of Pediatrics 1
Implementing long-term prevention strategies to reduce recurrence risk is essential, according to the Infectious Diseases Society of America 1, 6