Initial antibiotic therapy for staphylococcal scalded skin syndrome in children
Children with staphylococcal scalded skin syndrome require admission to hospital and intravenous antibiotics.
Empirical therapy should treat methicillin-susceptible Staphylococcus aureus (MSSA). Treatment for methicillin-resistant S. aureus (MRSA) is added for children who are severely unwell or have risk factors for infection with MRSA.
For children with staphylococcal scalded skin syndrome, use:
1cefazolin 50 mg/kg up to 2 g intravenously, 8-hourly. For children with septic shock or requiring intensive care support, use a 6-hourly dosing interval. See advice on modification and duration of therapy cefazolin
OR
1flucloxacillin 50 mg/kg up to 2 g intravenously, 6-hourly. For children with septic shock or requiring intensive care support, use a 4-hourly dosing interval. See advice on modification and duration of therapy flucloxacillin
PLUS if the child is severely unwell or has risk factors for MRSA infection
vancomycin intravenously; for initial dosing, see Principles of vancomycin use for children. See also advice on modification and duration of therapy. vancomycin
In some regions, based on local susceptibility data, clindamycin is a suitable alternative to vancomycin. If clindamycin is preferred, replace vancomycin in the above regimen with:
clindamycin 15 mg/kg up to 600 mg intravenously, 8-hourly1. See advice on modification and duration of therapy. clindamycin
There have been reports of clindamycin being added to antibiotic therapy because of a theoretical reduction in staphylococcal toxin production. However, evidence is lacking and this is not routinely recommendedBrazel, 2021Liy-Wong, 2021.The addition of clindamycin may be considered in severely unwell children; seek expert advice.
For children who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use the cefazolin regimen above.
For children who have had a severe immediate2 hypersensitivity reaction to a penicillin, the cefazolin regimen above can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).
For children who have had a severe immediate2 hypersensitivity reaction to a penicillin in whom cefazolin is not used, or for children who have had a severe delayed3 hypersensitivity reaction to a penicillin, use vancomycin alone (see dosage above).