Cellulitis: a prospective study.

We prospectively studied 20 children, ages 2 to 12 years, seen with cellulitis. Each child had a complete blood count, a blood culture, and a culture of an aspirate from the lesion. The age of the child, the fever, and the extent of cellulitis determined whether the child was hospitalized. Outpatient antibiotic therapy was penicillin or dicloxacillin. Four children (20%) had an infection on the upper extremity: 14 (70%), the leg; 1 (5%), the forehead; and one (5%), the periorbital area. Three children (15%) had a white blood cell (WBC) count greater than or equal to 15,000 cu mm. Two were febrile. One child with a WBC count less than or equal to 15,000 cu mm was febrile. Two blood cultures (10%) were positive, both for Haemophilus influenzae. Twelve organisms were isolated from the aspirates: 8 Staphylococcus aureus (all penicillinase producing), 2 H influenzae, 1 Streptococcus pyogenes, and 1 Pseudomonas aeruginosa. Both children with H influenzae were febrile with WBC counts greater than or equal to 15,000 cu mm. Of the 17 children (85%) treated as outpatients, all but one responded. We recommend admission and cultures of the blood and an aspirate of the lesion for all facial cellulitis and treatment with oxacillin and chloramphenicol. In a truncal or extremity cellulitis, initial therapy should be directed against S aureus. If the child is febrile or the WBC count greater than or equal to 15,000 cu mm, H influenzae is a likely pathogen and thus intravenous chloramphenicol must be used after cultures are obtained.