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Cellulitis: oral versus intravenous and home versus hospital—what makes clinicians decide?
  1. Laila F Ibrahim1,2,3,
  2. Franz E Babl1,4,5,
  3. Sandy M Hopper1,4,5,
  4. Penelope A Bryant1,2,3,6
  1. 1 Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
  2. 2 Clinical Paediatrics Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  3. 3 Hospital-In-The-Home, The Royal Children’s Hospital, Melbourne, Victoria, Australia
  4. 4 Emergency Department, The Royal Children’s Hospital, Melbourne, Victoria, Australia
  5. 5 Emergency Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  6. 6 Infectious Diseases Unit, Department of General Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
  1. Correspondence to Prof Franz E Babl, Emergency Department, Royal Children’s Hospital, Parkville VIC 3052, Australia; franz.babl{at}rch.org.au

https://doi.org/10.1136/archdischild-2019-316824

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    There is a lack of evidence-based guidance for management of cellulitis and use of outpatient parenteral antimicrobial therapy (OPAT) in children. The only published guidelines for skin infections are for adults.1 Lack of standardised guidelines for children can result in variation in paediatricians’ practice, with implications on care and resources.2 Our aim was to understand hospital paediatricians’ opinions about cellulitis management, important in reducing variation in care, regarding: (1) indications for using intravenous antibiotics, (2) indications for hospitalisation and (3) barriers to OPAT.

    This web-based anonymous survey was undertaken over 4 weeks at The Royal Children’s Hospital in Melbourne. Acute care paediatricians who diagnose and manage cellulitis were surveyed. Questions related to a clinical scenario (box 1), and none were mandatory.

    Box 1

    Clinical scenario

    A 3-year-old previously well girl presents to the emergency department with swelling and tenderness on her left shin after grazing her leg in the park when she fell. On examination, she has a temperature of 38.5°C but is systemically well, with an area of …

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    Footnotes

    • Contributors LFI conceptualised, designed and coordinated the study, contacted participants, drafted the initial manuscript and approved the final manuscript as submitted. PAB, FEB and SMH were involved in the design of the study, data analysis, reviewed and revised the manuscript and approved the final draft. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding This study was funded in part by grants from The Royal Children’s Hospital (RCH) Foundation, the Murdoch Children’s Research Institute (MCRI), the Victorian Department of Health, Melbourne, Australia. LFI was supported in part by a scholarship from AVANT Mutual Group Ltd, Melbourne, the Melbourne Children’s Campus Postgraduate Health Research Scholarship and the Doctor Nicholas Collins Fellowship. PAB was in part supported by a Melbourne Campus Clinician Scientist Fellowship, Melbourne, Australia. FEB was supported in part by a grant from the RCH Foundation and a Melbourne Campus Clinician Scientist Fellowship, Melbourne, Australia, and a National Health and Medical Research Council (NHMRC) Practitioner Fellowship, Canberra, Australia. The emergency research group, MCRI, is in part supported by an NHMRC Centre for Research Excellence Grant for Paediatric Emergency Medicine, Canberra, Australia, and the Victorian government infrastructure support programme.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.