Desired spectrum | First-line therapy | Second-line therapy |
SSTI and hemodynamic instability* | ||
MRSA MSSA Beta-hemolytic Streptococcus | Parenteral therapy: Vancomycin plus either:
| One of the following:
|
Oral therapy: Hemodynamically unstable children with SSTI should receive parenteral therapy | ||
Purulent/fluctuant SSTI (abscess, furuncle, carbuncle, purulent cellulitis) | ||
High prevalence of MRSAΔ or purulent/fluctuant SSTI of the face, hand, or perineum | ||
MRSA | Oral therapy with one of the following:
| One of the following:
|
Parenteral therapy with one of the following:¥
| One of the following: For patients of all ages:
| |
Low prevalence of MRSAΔ and SSTI not on face, hand, or perineum | ||
MSSA | Oral therapy with one of the following:
| One of the following:
|
Parenteral therapy with one of the following:
| One of the following:¥
| |
Cellulitis | ||
Risk factors for MRSA | ||
Beta-hemolytic Streptococcus MRSA | Oral therapy with one of the following:
| One of the following:
|
Parenteral therapy with one of the following:¥
| One of the following:
| |
No risk factors for MRSA | ||
Beta-hemolytic Streptococcus MSSA | Oral therapy with one of the following:
| One of the following:‡
|
Parenteral therapy with one of the following:
| One of the following:¥
| |
Erysipelas | ||
Beta-hemolytic Streptococcus | Oral therapy with one of the following:
| One of the following:
|
Parenteral therapy with one of the following:
| One of the following:
| |
Impetigo or folliculitis at multiple sites | ||
Beta-hemolytic Streptococcus MRSA | Oral therapy with one of the following:
| Patients who do not respond to initial therapy for beta-hemolytic Streptococcus and MRSA should be reevaluated for mimics of impetigo and other causes of folliculitis† |
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