Written by Kimi Dunbar
Spoon Feed
Clinical practice guidelines that emphasize the use of narrow-spectrum antibiotics for preseptal cellulitis can be useful in decreasing use of broad-spectrum antibiotics, particularly those targeted at MRSA.
Synopsis
This study assessed the impact of a clinical practice guideline (CPG) on antibiotic use and resource utilization for pediatric preseptal cellulitis. Implemented in 2020, the CPG emphasized narrow-spectrum antibiotic use and reduced the need for broad-spectrum and methicillin-resistant Staphylococcus aureus (MRSA) antibiotics, decreasing from 100% to 66% and 86% to 26%, respectively. Additionally, it reduced laboratory tests like blood cultures and complete blood counts. The results support CPGs as effective in promoting antibiotic stewardship and standardizing treatment. Continued refinement of CPGs may optimize management, minimizing unnecessary resource utilization in pediatric preseptal cellulitis. (AI-generated)
Periorbital cellulitis? Keep your eye on the source
Reading this study more carefully, the designed CPG recommends empiric antibiotic choice based on suspected source – cefazolin for presumed skin penetration, ampicillin-sulbactam for sinus or dental source; MRSA coverage was for severe infection, rapid worsening, or MRSA risk factors. The authors saw the greatest improvement in the use of empiric antibiotic choice in the skin penetration group (100% empiric broad spectrum to 49%). The study credits a large portion of their success to interdisciplinary collaboration including key stakeholders from pediatric hospital medicine, ENT, ophthalmology and infectious disease, including their local antibiotic stewardship team. Importantly, the authors mention the presence of the antibiotic stewardship team on daily inpatient rounds, and I wonder to what extent their presence impacted antibiotic choice compared to the CPG. Overall, this study highlights the importance of an evidence-based CPG to guide high-value medicine and the importance of source identification in antibiotic selection. As always, antibiotic selection should also be contingent on local antibiogram, and caution should be taken regarding rates of MRSA infection at one’s own institution. Notably, the rates at the article’s institution are low, <20% of all S. aureus isolates.
Source
Improving Antibiotic Use in Pediatric Preseptal Cellulitis Using a Clinical Practice Guideline. Hosp Pediatr. 2024 Oct 1;14(10):791-798. doi: 10.1542/hpeds.2023-007581. PMID: 39246158
