Modification and duration of therapy for staphylococcal scalded skin syndrome in children

In children being treated with intravenous therapy for staphylococcal scalded skin syndrome, switch to oral therapy when:

• the clinical features have improved
• the primary source of infection is controlled
• oral intake is tolerated.

Oral antibiotic choice should be based on antibiotic susceptibility testing, with dosing and duration of therapy based on the underlying infection. In children with staphylococcal scalded skin syndrome associated with a skin and soft tissue infection, the total duration of therapy (intravenous + oral) is typically 10 days. A suitable oral regimen might include:

In children with staphylococcal scalded skin syndrome, if adherence to a 6-hourly regimen is unlikely, a suitable oral regimen might be:

Cefalexin is often preferred to flucloxacillin in children, because the liquid formulation is better tolerated.

For children with penicillin hypersensitivity who tolerated initial intravenous therapy with cefazolin, cefalexin (at the dosages above) may be appropriate. Cefalexin can also be used for children with nonsevere (immediate or delayed) hypersensitivity to penicillins or children with severe immediate² hypersensitivity to a penicillin other than amoxicillin or ampicillin.

For children at increased risk of MRSA infection, or who have severe immediate² hypersensitivity reaction to amoxicillin or ampicillin or severe delayed³ hypersensitivity to any penicillin, use: