Common Community-acquired Bacterial Skin and Soft-tissue Infections in Children: an Intersociety Consensus on Impetigo, Abscess, and Cellulitis Treatment

Italian Pediatric Infectious Diseases Society, the Italian Pediatric Dermatology Society, Luisa Galli, Elisabetta Venturini, Andrea Bassi, Guido Castelli Gattinara, Elena Chiappini, Claudio Defilippi, Andrea Diociaiuti, Susanna Esposito, Silvia Garazzino, Antonietta Giannattasio, Andrzej Krzysztofiak, Stefano Latorre, Andrea Lo Vecchio, Paola Marchisio, Carlotta Montagnani, Giangiacomo Nicolini, Andrea Novelli, Gian Maria RossoliniChiara Tersigni, Alberto Villani, May El Hachem, Iria Neri

Research output: Contribution to journalReview article

Abstract

Purpose: The main objective of this article was to offer practical suggestions, given the existing evidence, for identifying and managing bacterial impetigo, abscess, and cellulitis in ambulatory and hospital settings. Methods: Five Italian pediatric societies appointed a core working group. In selected conditions, specially trained personnel evaluated quality assessment of treatment strategies according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Only randomized controlled trials (RCTs) and observational studies were included for quality assessment according to the GRADE methodology. MEDLINE, Ovid MEDLINE, EMBASE, and Cochrane Library databases were searched with a strategy combining MeSH and free text terms. Findings: The literature review included 364 articles focusing on impetigo, skin abscess, and cellulitis/orbital cellulitis. The articles included for quality assessment according to the GRADE methodology for impetigo comprised 5 RCTs and 1 observational study; for skin abscess, 10 RCTs and 3 observational studies were included; for cellulitis and erysipelas, 5 RCTs and 5 observational studies were included; and for orbital cellulitis, 8 observational studies were included. Recommendations were formulated according to 4 grades of strength for each specific topic (impetigo, skin abscesses, cellulitis, and orbital cellulitis). Where controversies arose and expert opinion was considered fundamental due to lack of evidence, agreement according to Delphi consensus recommendations was included. Implications: Based on a literature review and on local epidemiology, this article offers practical suggestions for use in both ambulatory and hospital settings for managing the most common bacterial SSTIs.

Original languageEnglish
Pages (from-to)532-551.e17
JournalClinical Therapeutics
Volume41
Issue number3
DOIs
Publication statusPublished - Mar 1 2019

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Keywords

  • abscess
  • cellulitis
  • children
  • impetigo
  • treatment

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Italian Pediatric Infectious Diseases Society, the Italian Pediatric Dermatology Society, Galli, L., Venturini, E., Bassi, A., Gattinara, G. C., Chiappini, E., Defilippi, C., Diociaiuti, A., Esposito, S., Garazzino, S., Giannattasio, A., Krzysztofiak, A., Latorre, S., Lo Vecchio, A., Marchisio, P., Montagnani, C., Nicolini, G., Novelli, A., ... Neri, I. (2019). Common Community-acquired Bacterial Skin and Soft-tissue Infections in Children: an Intersociety Consensus on Impetigo, Abscess, and Cellulitis Treatment. Clinical Therapeutics, 41(3), 532-551.e17. https://doi.org/10.1016/j.clinthera.2019.01.010