Trottier Evelyne D, Farley St-Amand Beatrice, Vincent Mélanie, Chevalier Isabelle, Autmizguine Julie, Tremblay Stéphanie, Gouin Serge
Department of Paediatric Emergency Medicine, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada.
Department of Paediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada.
Paediatr Child Health. 2022 May 3;27(4):213-219. doi: 10.1093/pch/pxac031. eCollection 2022 Jul.
To evaluate the effectiveness of a high-dose (HD) oral cephalexin treatment guideline for children with moderate cellulitis treated as outpatients.
In this retrospective cohort study, we included children who presented to the emergency department (ED) with moderate cellulitis and treated according to the institution's HD oral cephalexin guideline over a 2-year period. All children had standardized follow-up at a medical day hospital (MDH). Treatment was considered effective in the absence of treatment failure, defined as admission, switch to IV treatment or ED visit within 2 weeks of discharge from the MDH. Safety was ascertained by recording adverse events and severe complications at follow-up.
A total of 123 children were treated as outlined in the guideline, including 117 treated with HD oral cephalexin. The success rate was 89.7% (105/117). Among 12 (10.3%) children who had treatment failure, 10 (8.5%) required admission, 1 (0.9%) received IV antibiotics at the MDH and 1 (0.9%) had a return visit to the ED without admission. No severe complications were reported; four abscesses required drainage and one patient had a rash. The mean number of visits per child at the MDH was 1.6 (SD 1.0).
With a success rate of 89.7%, HD oral cephalexin seems effective and safe for the treatment of children with moderate cellulitis. Its use potentially reduces hospitalization rates for this condition and decreases the need for IV insertion.
评估高剂量（HD）口服头孢氨苄治疗指南对门诊治疗的中度蜂窝织炎儿童的有效性。
在这项回顾性队列研究中，我们纳入了在两年期间因中度蜂窝织炎到急诊科就诊并按照机构的HD口服头孢氨苄指南进行治疗的儿童。所有儿童均在医疗日间医院（MDH）接受标准化随访。若未出现治疗失败，即未在MDH出院后2周内入院、改用静脉治疗或到急诊科就诊，则认为治疗有效。通过记录随访时的不良事件和严重并发症来确定安全性。
共有123名儿童按照指南进行了治疗，其中117名接受了HD口服头孢氨苄治疗。成功率为89.7%（105/117）。在12名（10.3%）治疗失败的儿童中，10名（8.5%）需要入院，1名（0.9%）在MDH接受了静脉抗生素治疗，1名（0.9%）返回急诊科但未入院。未报告严重并发症；4例脓肿需要引流，1例患者出现皮疹。每个儿童在MDH的平均就诊次数为1.6次（标准差1.0）。
HD口服头孢氨苄治疗中度蜂窝织炎儿童的成功率为89.7%，似乎有效且安全。使用该药可能会降低这种疾病的住院率，并减少静脉穿刺的需求。
