Staphylococcal scalded skin syndrome: Difference between revisions
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==Treatment== | ==Treatment== | ||
*Often requires inpatient therapy, [[Fluid Resuscitation]], parenteral [[antibiotics]] | *Often requires inpatient therapy, [[Fluid Resuscitation]], parenteral [[antibiotics]] | ||
===[[Antibiotic]] Options=== | |||
*[[Nafcillin]] 100 mg/kg/d IV in 4 divided doses OR 50 mg/kg/d in 4 divided doses PO x7-10d | |||
*[[Penicillin G Procaine]] (300K U/d IM for <30 kg, 600K to 1 million U/d IM for >30 kg) | |||
*[[Amoxicillin/Clavulanate]] 45 mg/kg/d PO in 2 divided doses x 7-10d | |||
*[[Cefazolin]] 100 mg/kg/d IV in 4 divided doses | |||
*[[Cephalexin]] 40 mg/kg/d in 4 divided doses x 7-10d | |||
*If possible [[MRSA]]: | |||
**[[Clindamycin]] 40mg/kg/d IV or PO in 4 divided doses x7-10d | |||
**[[Bactrim]] 10 mg/kg/d in 2 divided doses x7-10d | |||
**[[Vancomycin]] 10-15mg/kg/d in 2 divided doses up to 1 gm q12hr | |||
==Disposition== | ==Disposition== | ||
Revision as of 23:34, 26 February 2016
Background
- Caused by Staph aureus
- Most pts <2yr old, nearly all <6 yr old
Clinical Features
- Rash progresses from erythroderma to extensive areas of exfoliation
- Systemic symptoms (malaise, fever, irritability, skin tenderness) are common
- Nikolsky sign (separation of epidermis when pressure is applied) is present
- No mucous membrane involvement (differentiate from SJS/TENS)
Differential Diagnosis
- Erythema Multiforme
- Staphlococcal scalded skin syndrome
- Erythroderma
- Toxic Shock Syndrome
- Drug eruption
- Pemphigus vulgaris
Diagnosis[1]
- PCR for toxin if available
- CBC - leukocytosis, though normal WBC level oftenly
- ESR elevation
- Monitor electrolytes, renal function closely in severe disease
- Blood cultures variably positive (more often pos in adults)
- CXR to r/o pna
Treatment
- Often requires inpatient therapy, Fluid Resuscitation, parenteral antibiotics
Antibiotic Options
- Nafcillin 100 mg/kg/d IV in 4 divided doses OR 50 mg/kg/d in 4 divided doses PO x7-10d
- Penicillin G Procaine (300K U/d IM for <30 kg, 600K to 1 million U/d IM for >30 kg)
- Amoxicillin/Clavulanate 45 mg/kg/d PO in 2 divided doses x 7-10d
- Cefazolin 100 mg/kg/d IV in 4 divided doses
- Cephalexin 40 mg/kg/d in 4 divided doses x 7-10d
- If possible MRSA:
- Clindamycin 40mg/kg/d IV or PO in 4 divided doses x7-10d
- Bactrim 10 mg/kg/d in 2 divided doses x7-10d
- Vancomycin 10-15mg/kg/d in 2 divided doses up to 1 gm q12hr
Disposition
- Transfer to burn center if diffuse
- Localized infection may d/c home w/ f/u
See Also
Source
Tintinalli
- ↑ Randall WK et al. Staphylococcal Scalded Skin Syndrome Workup. eMedicine. Oct 28, 2015. http://emedicine.medscape.com/article/788199-workup.