This protocol applies to children and young people aged 1 month to under 18 years who present with erysipelas involving skin near the eyes or nose — a location requiring particular attention — and for whom penicillin is contraindicated due to allergy, or for whom co-amoxiclav is otherwise unsuitable.
When the standard first-choice antibiotic options are not appropriate due to a history of penicillin allergy or because co-amoxiclav is unsuitable, an alternative antibiotic approach is indicated. Specialist advice should be considered, particularly given the periorbital or perinasal location of the infection.
An oral macrolide antibiotic is the cornerstone of the alternative regimen for this group, given for a defined course. When anaerobic involvement is suspected, an additional antibiotic may be added alongside. The complete age- and weight-based regimen, including the intravenous option for those unable to take oral treatment or who are severely unwell, is in the full protocol.
Symptoms are expected to begin improving within 2 to 3 days of starting treatment. Full resolution of symptoms at 5 to 7 days is not expected — skin takes some time to return to normal. Seek medical review promptly if symptoms worsen rapidly or do not begin to improve within the expected window.