Etiology and treatment of facial cellulitis in pediatric patients

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Abstract
By a retrospective chart review patients with buccal cellulitis were divided into groups with and without a probable portal of entry of infection at the time of diagnosis. Tooth abscesses or breaks in the skin were the usual portals of entry. Patients with a portal of entry were significantly older (P < 0.001), had lower white blood cell counts on admission (P < 0.01) and recovered more rapidly (P = 0.001). Haemophilus influenzae type b was recovered only from those with no portal of entry. Staphylococcus aureus and Streptococcus pyogenes caused infection in both groups but were more frequent in those with a portal of entry. Bacteremia was proved only in the group with no portal, and H. influenzae b grew from 14 of 15 positive blood cultures. All cultures of cerebro-spinal fluid yielded no growth. We suggest that patients with no portal of entry on presentation receive initial parenteral therapy for H. influenzae b and Gram-positive cocci. Our current regimen is a combination of a semisynthetic penicillinase-resistant penicillin such as oxacillin and chloramphenicol. Oxacillin alone is indicated for those with a break in the skin leading to infection, whereas penicillin is appropriate for patients with dental infection. This initial therapy should be altered depending upon culture results when available.

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