Mild

*Cloxacillin 50-100mg/kg/day PO in 4 divided doses (max. 1g/day) for 5-7 days

Severe

Cloxacillin 200mg/kg/day IV in 4 divided doses (max. 12g/day) for 5-7 days

CA-MRSA

Clindamycin 30-40mg/kg/day PO in 3-4 divided doses (max. 1.8g/day) for 5-7 days

OR

Trimethoprim/sulfamethoxazole 8-12mg/kg/day (TMP dose) PO in 2 divided doses (max. 320mg/day) for 5-7 days 

Mild

Cephalexin 25-50mg/kg/day PO in 2 divided doses (max. 2g/day) for 5-7 days 

Incision & drainage (I&D) is the MAINSTAY of therapy. If needle aspiration is inadequate, can send pus obtained during I&D for C&S.

Use parenteral route for severe infections. Consider CA-MRSA if poorly resolving, based on local epidemiology (still generally uncommon).

*Doses recommended are for children weighing less than 25kg. For children weighing more than 25kg, use adult dosage (500mg PO q6h).

Mild

*Cloxacillin 50-100mg/kg/day PO in 4 divided doses (max. 1g/day) for 5-7 days

Severe

Cloxacillin 200mg/kg/day IV in 4 divided doses (max. 12g/day) for 5-7 days

Cephalexin 25-50mg/kg/day PO in 2 divided doses (max. 2g/day) for 5-7 days 

Administer using parenteral route for extensive lesions. 

Total treatment until 3 days after acute inflammation disappears.

*Doses recommended are for children weighing less than 25kg. For children weighing more than 25kg, use adult dosage (500mg PO q6h).

˂ 10 years old or < 40kg

Rifampicin 10mg/kg PO (max. 600mg/day) once a month

PLUS

Dapsone 2mg/kg PO q24h (max. 100mg/day)

PLUS

Clofazimine 100mg PO once a month, 50mg twice weekly

10-14 years old

Rifampicin 450mg PO (max. 600mg/day) once a month

PLUS

Dapsone 50mg PO q24h (max. 100mg/day)

PLUS

Clofazimine 150mg PO once a month & 50mg alternate day

--

Duration:

Paucibacillary: 6 months

Surveillance 5 years

Multibacillary: 12 months

Surveillance 15 years

Localised:

Topical 2% fusidic acid 2-3 times daily for 7 days (outpatient)

Generalised:

*Cloxacillin 50-100mg/kg/day PO in 4 divided doses (max. 1g/day) for 5-7 days

Localised:

Topical 2% Mupirocin cream 2-3 times daily for 7 days 

Generalised:

Cephalexin 25-50mg/kg/day PO in 2 divided doses (max. 2g/day) for 5-7 days

*Doses recommended are for children weighing less than 25kg. For children weighing more than 25kg, use adult dosage (500mg PO q6h).

Benzylpenicillin 200,000-300,000units/kg/day IV in 4-6 divided doses (max. 24 million units/day)

PLUS

Clindamycin 10mg/kg IV q6h (max: 4.8g/day)

--

50% of patients have associated streptococcal toxic shock syndrome (STSS).

Prompt and aggressive surgical debridement of the deep-seated infection is the mainstay of therapy.

Tissues should be sent for Gram stain and culture to determine etiology.

Combination therapy is needed with clindamycin to block toxin production whether or not patient manifests toxic shock syndrome.

IVIG can be used as an adjunct in Group A streptococcal infection, typically at 1g/kg on Day 1, followed by 0.5g/kg on 1-2 subsequent days.

Duration: at least 2 weeks if no foci is found (no deep-seated involvement plus no involvement of heart, bone, joint etc.)

Cloxacillin 200mg/kg/day IV in 4-6 divided doses (max. 1g/day)

PLUS

Clindamycin 10mg/kg IV q6h (max: 4.8g/day)

If CA-MRSA is suspected:

Vancomycin 60mg/kg/day IV in 3-4 divided doses (max. 2g/day)

Prompt and aggressive surgical debridement of the deep-seated infection is the mainstay of therapy.

Tissues should be sent for Gram stain and culture to determine etiology.

Combination therapy is needed with clindamycin to block toxin production whether or not patient manifests toxic shock syndrome.

Vancomycin is NOT RECOMMENDED for the treatment of serious MSSA infections because outcomes are INFERIOR compared with cases in which anti-staphylococcus β-lactam (cloxacillin) is used AND to minimise the emergence of vancomycin resistance.

Duration: at least 2 weeks if no foci is found (no deep-seated involvement plus no involvement of heart, bone, joint etc.)

Cloxacillin 200mg/kg/day IV in 4-6 divided doses (max. 12g/day)

Step down

Cloxacillin 25-50mg/kg/day PO in 4 divided doses (max. 1g/day)

Total treatment duration: 7-10 days

--

Switch to oral therapy when the patient shows clinical improvement and negative blood culture results.

Doses recommended are for children weighing less than 25kg. For children weighing more than 25kg, use adult dosage. 

Amoxicillin/clavulanate

Amoxycillin component:

Suspension (Formulation 14:1)

Amoxicillin / Clavulanate 80-90mg/kg/day PO in 2 divided doses (max. amoxicillin 2g/day) for 5-7 days

Suspension (Formulation 7:1)

Amoxicillin / Clavulanate 40-45mg/kg/day PO in 2 divided doses (max. amoxicillin 2g/day) for 5-7 days

Amoxicillin/clavulanate 25mg/kg/dose (amoxicillin component) IV q8h (max. amoxicillin 3g/day)

Consider rabies prophylaxis according to local epidemiology.

Other animal bites: to discuss with ID Physician.

Amoxicillin/clavulanate 

Amoxycillin component:

Suspension (Formulation 14:1)

Amoxicillin / Clavulanate 80-90mg/kg/day PO in 2 divided doses (max. amoxicillin 2g/day) for 5-7 days

Suspension (Formulation 7:1)

Amoxicillin / Clavulanate 40-45mg/kg/day PO in 2 divided doses (max. amoxicillin 2g/day) for 5-7 days

Amoxicillin/clavulanate 25mg/kg/dose (amoxicillin component) IV q8h (max. amoxicillin 3g/day)

OR

Clindamycin 20-40mg/kg/day IV in 3 divided doses (max. 4.8g/day)

PLUS 

Co-trimoxazole 8-10mg (TMP)/kg/day IV in 2 divided doses (max. 320mg TMP/day)

Consider rabies prophylaxis according to local epidemiology.

Other animal bites, to discuss with ID Physician.

Infant < 2 months

Sulphur 6% in petroleum in ointment base for 3 days

Children < 2 years

Two applications of Permethrin 5% for 8-12 hours at one week apart

Children < 12 years

Two applications of permethrin 5% for 8-12hours at one week apart 

Nodular scabies

Children < 2 years

Crotamiton cream TDS for 5-7 days

Children < 12 years

Crotamiton cream TDS for 7-14 days

Children < 2 years

Sulphur 6% in petroleum in ointment base for 3 days

Children < 12 years

Benzyl Benzoate 12.5% Whole body neck and below for 3 consecutive days

Treat whole body including the face (avoid eyes and mouth).

Treat all family members/close contacts simultaneously.

Refer to Ministry of Health Guideline for Management of Scabies in Adults and Children (2015) for cautions and topical application method.

Griseofulvin 10-20mg/kg/day PO daily (max. 750mg/day) for at least 6 weeks until clinically clear

Terbinafine 4-6mg/kg/day PO daily (max. 250mg/day) for 4 weeks or longer depend on pathogen

10-20kg: 62.5mg daily

20-40kg: 125mg daily

> 40kg: 250mg daily

OR

Itraconazole 3-5mg/kg/day PO daily (max. 200mg/day) for 2-6 weeks 

OR

Fluconazole 5-6mg/kg/day PO (max. 300mg/day) for 3-6 weeks 

Griseofulvin:

First line treatment for Microsporum sp

Take with fatty food. Monitor liver function if treatment duration > 8 weeks

Adjunctive selenium or ketoconazole shampoo can reduce transmissibility.