{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:17:04Z","timestamp":1789697824352,"version":"4.0.1"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2022,5,3]],"date-time":"2022-05-03T00:00:00Z","timestamp":1651536000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7,18]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To evaluate the effectiveness of a high-dose (HD) oral cephalexin treatment guideline for children with moderate cellulitis treated as outpatients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective cohort study, we included children who presented to the emergency department (ED) with moderate cellulitis and treated according to the institution\u2019s 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1093\/pch\/pxac031","type":"journal-article","created":{"date-parts":[[2022,5,5]],"date-time":"2022-05-05T17:29:17Z","timestamp":1651771757000},"page":"213-219","source":"Crossref","is-referenced-by-count":6,"title":["Outpatient management of moderate cellulitis in children using high-dose oral cephalexin"],"prefix":"10.1093","volume":"27","author":[{"given":"Evelyne D","family":"Trottier","sequence":"first","affiliation":[{"name":"Department of Paediatric Emergency Medicine, Universit\u00e9 de Montr\u00e9al, Centre Hospitalier Universitaire Sainte-Justine , Montr\u00e9al, Qu\u00e9bec , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Farley St-Amand","sequence":"additional","affiliation":[{"name":"Department of Paediatric Emergency Medicine, Universit\u00e9 de Montr\u00e9al, Centre Hospitalier Universitaire Sainte-Justine , Montr\u00e9al, Qu\u00e9bec , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e9lanie","family":"Vincent","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Universit\u00e9 de Montr\u00e9al, Centre Hospitalier Universitaire Sainte-Justine , Montr\u00e9al, Qu\u00e9bec , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Chevalier","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Universit\u00e9 de Montr\u00e9al, Centre Hospitalier Universitaire Sainte-Justine , Montr\u00e9al, Qu\u00e9bec , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Autmizguine","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Universit\u00e9 de Montr\u00e9al, Centre Hospitalier Universitaire Sainte-Justine , Montr\u00e9al, Qu\u00e9bec , Canada"},{"name":"Department Pharmacology and Physiology, Universit\u00e9 de Montr\u00e9al, Centre Hospitalier Universitaire Sainte-Justine , Montr\u00e9al, Qu\u00e9bec , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phanie","family":"Tremblay","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Universit\u00e9 de Montr\u00e9al, Centre Hospitalier Universitaire Sainte-Justine , Montr\u00e9al, Qu\u00e9bec , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serge","family":"Gouin","sequence":"additional","affiliation":[{"name":"Department of Paediatric Emergency Medicine, Universit\u00e9 de Montr\u00e9al, Centre Hospitalier Universitaire Sainte-Justine , Montr\u00e9al, Qu\u00e9bec , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,5,3]]},"reference":[{"key":"2022071815214905400_CIT0001","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1086\/605434","article-title":"Epidemiology of dermatitis and skin infections in United States physicians\u2019 offices, 1993\u20132005","volume":"49","author":"Pallin","year":"2009","journal-title":"Clin Infect Dis"},{"key":"2022071815214905400_CIT0002","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1001\/archinte.168.14.1585","article-title":"National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections","volume":"168","author":"Hersh","year":"2008","journal-title":"Arch Intern Med"},{"key":"2022071815214905400_CIT0003","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1097\/PEC.0b013e31815a032f","article-title":"Management of cellulitis in a pediatric emergency department","volume":"23","author":"Khangura","year":"2007","journal-title":"Pediatr Emerg Care"},{"key":"2022071815214905400_CIT0004","first-page":"206","article-title":"Cellulite in Dictionnaire de p\u00e9diatrie Weber 3e ed.","author":"Sanchez","year":"2015"},{"key":"2022071815214905400_CIT0005","doi-asserted-by":"crossref","first-page":"ofv181","DOI":"10.1093\/ofid\/ofv181","article-title":"Etiology of cellulitis and clinical prediction of streptococcal disease: A prospective study","volume":"3","author":"Bruun","year":"2016","journal-title":"Open Forum Infect Dis"},{"issue":"Suppl 4","key":"2022071815214905400_CIT0006","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/S0929-693X(01)80193-7","article-title":"[Cellulitis in children]","volume":"8","author":"Olivier","year":"2001","journal-title":"Archives de P\u00e9diatrie"},{"key":"2022071815214905400_CIT0007","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1056\/NEJM199601253340407","article-title":"Streptococcal infections of skin and soft tissues","volume":"334","author":"Bisno","year":"1996","journal-title":"N Engl J Med"},{"key":"2022071815214905400_CIT0008","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1001\/archderm.1989.01670180051004","article-title":"Streptococcal cause of erysipelas and cellulitis in adults. A microbiologic study using a direct immunofluorescence technique","volume":"125","author":"Bernard","year":"1989","journal-title":"Arch Dermatol"},{"key":"2022071815214905400_CIT0009","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1111\/j.1440-1754.2007.01236.x","article-title":"Prospective evaluation of the management of moderate to severe cellulitis with parenteral antibiotics at a paediatric day treatment centre","volume":"44","author":"Gouin","year":"2008","journal-title":"J Paediatr Child Health"},{"key":"2022071815214905400_CIT0010","volume-title":"Harrison\u2019s Principles of Internal Medicine.","author":"Kassir","year":"2015","edition":"19"},{"key":"2022071815214905400_CIT0011","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1093\/cid\/ciu444","article-title":"Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin Infect Dis"},{"key":"2022071815214905400_CIT0012","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1136\/archdischild-2019-316824","article-title":"Cellulitis: Oral versus intravenous and home versus hospital-what makes clinicians decide?","volume":"105","author":"Ibrahim","year":"2020","journal-title":"Arch Dis Child"},{"key":"2022071815214905400_CIT0013","doi-asserted-by":"crossref","first-page":"e718","DOI":"10.1542\/peds.2012-0746","article-title":"Trends in resource utilization for hospitalized children with skin and soft tissue infections","volume":"131","author":"Lopez","year":"2013","journal-title":"Pediatrics"},{"issue":"10","key":"2022071815214905400_CIT0014","doi-asserted-by":"crossref","first-page":"519","DOI":"10.5694\/j.1326-5377.1998.tb123398.x","article-title":"Home-based treatment of cellulitis with twice-daily cefazolin.","volume":"169","author":"Leder","year":"1998","journal-title":"Clinical Trial Med J Aust"},{"key":"2022071815214905400_CIT0015","first-page":"1","article-title":"Outpatient parenteral antimicrobial therapy and judicious use of pediatric emergency resources","volume":"00","author":"Xu","year":"2017","journal-title":"Pediatr Emerg Care"},{"key":"2022071815214905400_CIT0016","doi-asserted-by":"crossref","first-page":"e247","DOI":"10.1097\/PEC.0000000000001215","article-title":"Outpatient parenteral antimicrobial therapy and judicious use of pediatric emergency resources","volume":"36","author":"Xu","year":"2020","journal-title":"Pediatr Emerg Care"},{"key":"2022071815214905400_CIT0017","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/PEC.0b013e3181d1de08","article-title":"Pediatric cellulitis: Success of emergency department short-course intravenous antibiotics","volume":"26","author":"Kam","year":"2010","journal-title":"Pediatr Emerg Care"},{"key":"2022071815214905400_CIT0018","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/INF.0000000000000992","article-title":"Who can have parenteral antibiotics at home? A prospective observational study in children with moderate\/severe cellulitis","volume":"35","author":"Ibrahim","year":"2016","journal-title":"Pediatr Infect Dis J"},{"key":"2022071815214905400_CIT0019","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/S1473-3099(18)30729-1","article-title":"Efficacy and safety of intravenous ceftriaxone at home versus intravenous flucloxacillin in hospital for children with cellulitis (CHOICE): A single-centre, open-label, randomised, controlled, non-inferiority trial","volume":"19","author":"Ibrahim","year":"2019","journal-title":"Lancet Infect Dis"},{"key":"2022071815214905400_CIT0020","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1186\/s12879-017-2569-4","article-title":"Role of outpatient parenteral antibiotic therapy in the treatment of community acquired skin and soft tissue infections in Singapore","volume":"17","author":"Chan","year":"2017","journal-title":"BMC Infect Dis"},{"key":"2022071815214905400_CIT0021","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1136\/emj.2004.018143","article-title":"Emergency department management of home intravenous antibiotic therapy for cellulitis","volume":"22","author":"Donald","year":"2005","journal-title":"Emerg Med J"},{"key":"2022071815214905400_CIT0022","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1136\/bmj.38309.447975.EB","article-title":"Randomised controlled trial of intravenous antibiotic treatment for cellulitis at home compared with hospital","volume":"330","author":"Corwin","year":"2005","journal-title":"BMJ"},{"key":"2022071815214905400_CIT0023","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1007\/s40272-016-0181-5","article-title":"Managing pediatric pain in the emergency department","volume":"18","author":"Bailey","year":"2016","journal-title":"Paediatr Drugs"},{"key":"2022071815214905400_CIT0024","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1093\/pch\/pxz026","article-title":"Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures","volume":"24","author":"Trottier","year":"2019","journal-title":"Paediatr Child Health"},{"key":"2022071815214905400_CIT0025","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1097\/PEC.0000000000000669","article-title":"An evidence-based approach to minimizing acute procedural pain in the emergency department and beyond","volume":"32","author":"Ali","year":"2016","journal-title":"Pediatr Emerg Care"},{"key":"2022071815214905400_CIT0026","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1542\/hpeds.2014-0084","article-title":"Pain outcomes in a US children\u2019s hospital: A prospective cross-sectional aurvey","volume":"5","author":"Friedrichsdorf","year":"2015","journal-title":"Hosp Pediatr"},{"issue":"7","key":"2022071815214905400_CIT0027","doi-asserted-by":"crossref","first-page":"1888","DOI":"10.1093\/jac\/dky120","article-title":"imitations of ceftriaxone compared with cefazolin against MSSA: An integrated pharmacodynamic analysis.","volume":"73","author":"Zelenitsky","year":"2018","journal-title":"J Antimicrob Chemother"},{"key":"2022071815214905400_CIT0028","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1093\/cid\/cit122","article-title":"Clinical trial: Comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: A randomized controlled trial","volume":"56","author":"Pallin","year":"2013","journal-title":"Clin Infect Dis"},{"key":"2022071815214905400_CIT0029","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1001\/jama.2017.5653","article-title":"Effect of cephalexin plus trimethoprim-sulfamethoxazole vs cephalexin alone on clinical cure of uncomplicated cellulitis: A randomized clinical trial","volume":"317","author":"Moran","year":"2017","journal-title":"JAMA"},{"key":"2022071815214905400_CIT0030","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1097\/INF.0b013e3182a222a6","article-title":"Pharmacokinetics and pharmacodynamics of oral cephalexin in children with osteoarticular infections","volume":"32","author":"Autmizguine","year":"2013","journal-title":"Pediatr Infect Dis J"},{"key":"2022071815214905400_CIT0031","article-title":"Cellulite, infection cutan\u00e9e.","volume-title":"Document original: Traitement ambulatoire des cellulites mod\u00e9r\u00e9es via le centre de jour de p\u00e9diatrie 2013","author":"Vincent"},{"key":"2022071815214905400_CIT0032","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1097\/MLR.0000000000000487","article-title":"Cost analysis of the STONE randomized trial: Can health care costs be reduced one test at a time?","volume":"54","author":"Melnikow","year":"2016","journal-title":"Med Care"},{"key":"2022071815214905400_CIT0033","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1097\/TP.0b013e31816a3267","article-title":"Case-control comparison of at-home and hospital care for allogeneic hematopoietic stem-cell transplantation: Trole of oral nutrition","volume":"85","author":"Svahn","year":"2008","journal-title":"Transplantation"},{"key":"2022071815214905400_CIT0034","doi-asserted-by":"crossref","first-page":"e469","DOI":"10.1542\/peds.2004-0421","article-title":"Treatment of urinary tract infections among febrile young children with daily intravenous antibiotic therapy at a day treatment center","volume":"114","author":"Gauthier","year":"2004","journal-title":"Pediatrics"},{"key":"2022071815214905400_CIT0035","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/j.amjmed.2013.08.016","article-title":"Avoidable antibiotic exposure for uncomplicated skin and soft tissue infections in the ambulatory care setting","volume":"126","author":"Hurley","year":"2013","journal-title":"Am J Med"},{"key":"2022071815214905400_CIT0036","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1097\/01.pec.0000236832.23947.a0","article-title":"Evolving epidemiology of pediatric Staphylococcus aureus cutaneous infections in a Baltimore hospital","volume":"22","author":"Chen","year":"2006","journal-title":"Pediatr Emerg Care"},{"key":"2022071815214905400_CIT0037","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1086\/430312","article-title":"Three-year surveillance of community-acquired Staphylococcus aureus infections in children","volume":"40","author":"Kaplan","year":"2005","journal-title":"Clin Infect Dis"},{"key":"2022071815214905400_CIT0038","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1001\/archpedi.159.10.980","article-title":"Epidemic of community-acquired methicillin-resistant Staphylococcus aureus infections: A 14-year study at Driscoll Children\u2019s Hospital","volume":"159","author":"Purcell","year":"2005","journal-title":"Arch Pediatr Adolesc Med"},{"key":"2022071815214905400_CIT0039","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.3201\/eid1509.081228","article-title":"Trends in US hospital admissions for skin and soft tissue infections","volume":"15","author":"Edelsberg","year":"2009","journal-title":"Emerg Infect Dis"},{"key":"2022071815214905400_CIT0040","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1542\/peds.2013-1384","article-title":"Blood cultures in the evaluation of uncomplicated skin and soft tissue infections","volume":"132","author":"Malone","year":"2013","journal-title":"Pediatrics"},{"key":"2022071815214905400_CIT0041","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1097\/INF.0000000000000938","article-title":"Blood cultures in cellulitis are not cost effective and should prompt investigation for an alternative focus","volume":"35","author":"Bryant","year":"2016","journal-title":"Pediatr Infect Dis J"},{"key":"2022071815214905400_CIT0042","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.annemergmed.2007.12.004","article-title":"Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus","volume":"51","author":"Pallin","year":"2008","journal-title":"Ann Emerg Med"},{"issue":"2","key":"2022071815214905400_CIT0043","doi-asserted-by":"crossref","first-page":"e20181420","DOI":"10.1542\/peds.2018-1420","article-title":"Development and validation of a cellulitis risk score: The Melbourne ASSET score","volume":"143","author":"Ibrahim","year":"2019","journal-title":"Pediatrics"}],"container-title":["Paediatrics &amp; Child Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/pch\/article-pdf\/27\/4\/213\/45021371\/pxac031.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/pch\/article-pdf\/27\/4\/213\/45021371\/pxac031.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T03:06:45Z","timestamp":1700536005000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/pch\/article\/27\/4\/213\/6578118"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,3]]},"references-count":43,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,5,3]]},"published-print":{"date-parts":[[2022,7,18]]}},"URL":"https:\/\/doi.org\/10.1093\/pch\/pxac031","relation":{},"ISSN":["1205-7088","1918-1485"],"issn-type":[{"value":"1205-7088","type":"print"},{"value":"1918-1485","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,7,1]]},"published":{"date-parts":[[2022,5,3]]}}}