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Although many skin infections in children are still best treated with older agents, several newer antibiotics offer advantages in certain situations. In addition, changes in microbial antibiotic resistance patterns have altered the drug of choice for certain childhood skin and soft tissue infections .
Systemic antibiotics to eradicate Staphylococci and Streptococci are the treatment of choice in skin and soft tissue infections in children . It is now recognised that penicillinase producing staphylococci are more likely to be responsible for impetigo than streptococci and account for 70% to 80% of childhood impetigo . For impetigo secondary to an underlying skin disease, such as dermatitis, scabies, psoriasis or varicella, staphylococci are virtually always responsible . Post-streptococcal glomerulonephritis may follow such infections of the skin if nephritogenic strains of streptococci are involved .
Beta-lactamase production is one of the most common forms of resistance to beta- lactam antibiotics. The most recent advances has been the introduction of beta- lactamase inhibitors, which, when combined with existing beta-lactam antibiotics, act synergestically by inhibiting plasmid mediated beta-lactamases of Staphylococcus aureus .
The antimicrobial spectrum of amoxycillin/clavulanic acid combination make them ideally suited for the treatment of serious infections of the skin and soft tissue when polymicrobial organisms are suspected .
Most topical antibiotics including mupirocin ointment may result in clinical improvement but may prolong the carriage stage of pathogen on the skin . Topical mupirocin ointment should not be used alone but reserved for cutaneous staphylococcal infections such as encountered in immunosuppressed children .
It is concluded that amoxicillin-clavulanic acid combination, with good coverage of Staph aureus and Streptococci is useful in mild skin and soft tissue infections in children or for oral treatment after an impatient course of intravenous antibiotics in moderate to severe skin and soft tissue infections in children .