Pin-site infection
Improved pin-site care may be sufficient to treat mild inflammation (eg slight erythema, minimal exudate) at the site of orthopaedic pins and wires. Treat superficial infection (eg increased erythema, warmth, exudate or pain at the pin site) with a short course of antibiotics targeting Staphylococcus aureus, and seek expert orthopaedic advice for consideration of pin removal. Swab exudate for culture. While awaiting the results of culture and susceptibility testing, use:
1dicloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 7 days. For dosage adjustment in adults with kidney impairment, see dicloxacillin dosage adjustment dicloxacillin dicloxacillin dicloxacillin
OR
1flucloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 7 days. For dosage adjustment in adults with kidney impairment, see flucloxacillin oral dosage adjustment. flucloxacillin flucloxacillin flucloxacillin
Cefalexin is often preferred to dicloxacillin and flucloxacillin in children because the liquid formulation is better tolerated. It can also be used for patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin1. Use:
1cefalexin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 7 days. For dosage adjustment in adults with kidney impairment, see cefalexin dosage adjustment cefalexin cefalexin cefalexin
OR if adherence to a 6-hourly regimen is unlikely in a child
1cefalexin 20 mg/kg up to 750 mg orally, 8-hourly for 7 days2.
For patients who have had a severe (immediate or delayed)3 hypersensitivity reaction to a penicillin, use:
clindamycin 450 mg (child: 10 mg/kg up to 450 mg) orally, 8-hourly for 7 days.clindamycinclindamycinclindamycin
Modify therapy according to the results of culture and susceptibility testing.
If there are systemic symptoms or pin loosening, or if signs of infection fail to respond to a short course of oral antibiotic therapy, seek expert orthopaedic advice.