Treatment of Erysipelas in Children with Penicillin Allergy (Age 1 Month to Under 18 Years)
When a child aged 1 month to under 18 years presents with erysipelas and has a documented penicillin allergy — or flucloxacillin is otherwise unsuitable — standard first-line antibiotic choices cannot be used. This protocol covers the specific antibiotic approach for that scenario, in cases where the infection is not near the eyes or nose.
Clinical Scenario
Penicillin Allergy / Flucloxacillin Unsuitable- Age: 1 month to under 18 years
- Penicillin allergy documented, or flucloxacillin otherwise unsuitable
- Infection site: not near the eyes or nose
Treatment Approach
Alternative antibiotic options are available — given orally where possible, or intravenously when the patient cannot take oral medication or is severely unwell. A short course is indicated, with the specific agent and formulation determined by age and individual clinical factors. The full selection guidance is in the complete protocol.
Expected Response
Symptoms should begin to improve within 2 to 3 days. Full resolution of symptoms at 5 to 7 days is not expected — skin takes time to return to normal. Seek medical review if symptoms worsen rapidly or significantly at any time, or do not start to improve within 2 to 3 days.
References
- table 2 for children and young people under 18 years
- Alternative first-choice antibiotics for penicillin allergy or if flucloxacillin unsuitable (give orally unless person unable to take oral or severely unwell)
- Co-amoxiclav (not in penicillin allergy; 5 to 7 days)
- Clarithromycin (5 to 7 days)
- Erythromycin (in pregnancy; 5 to 7 days)
- seeking medical help if symptoms worsen rapidly or significantly at any time, or do not start to improve within 2 to 3 days.
- However, skin does take some time to return to normal, and full resolution of symptoms at 5 to 7 days is not expected.