SKIN - Paronychia (Staphylococcus aureus) In thumbsuckers and nailbiters may also be caused by Group A Streptococcus or anaerobes. May require incision & drainage.

Dicloxacillin

(Dynapen^®)

Generics available

Pregnancy: B; Lactation: Unk

Caps: 125 mg, 250 mg, 500 mg

Oral Susp: 62.5 mg/5 mL, 200 mL

Children ≤40 kg: 25-50 mg/kg/day (max 2 g/day) in divided doses every 6 hours for 10-14 days.

62.5 mg/5 mL @ 25 mg/kg/day (double for 50 mg/kg)

10 kg (22 lb) = 1 tsp (5 mL) Q6H

15 kg (33 lb) = 1½ tsp (7.5 mL) Q6H

20 kg (44 lb) = 2 tsp (10 mL) Q6H

40 kg (88 lb) = Use adult dose.

Children ≥40 kg and Adult: 250-500 mg PO four times daily for 10-14 days.

Food: Take 1 hour before or 2 hours after meals.

Important side effects: Bad taste, GI upset.

Cephalexin

(Keflex^®)

Generics available

Pregnancy: B; Lactation: Unk

Tabs: 250 mg, 500 mg, 1 g

Caps: 250 mg, 500 mg

Oral Susp:

125 mg/5 mL, 250 mg/5 mL

Children: 25-50 mg/kg/day (max 4 g/day) in divided doses two to four times daily for 10-14 days.

125 mg/5 mL @ 25 mg/kg/day (double for 50 mg/kg)

10 kg (22 lb) = ½ tsp (2.5 mL) Q6H

15 kg (33 lb) = ¾ tsp Q6H

20 kg (44 lb) = 1 tsp (5 mL) Q6H

250 mg/5 mL @ 25 mg/kg/day (double for 50 mg/kg)

20 kg (44 lb) = ½ tsp (2.5 mL) Q6H

40 kg (88 lb) = 1 tsp (5 mL) Q6H

>40 kg = Use adult dose.

Adult: 250-500 mg four times daily for 10-14 days.

Food: May take with food if GI upset occurs.

Important side effects: GI upset, diarrhea.

Reduce dose in renal disease

(CrCl <40 mL/min).

Amoxicillin/clavulanate

(Augmentin^®)

DOC for thumbsuckers and nailbiters.

Pregnancy: B; Lactation: Unk

Q12H Formulations:

Tabs: 500 mg/125 mg, 875 mg/125 mg

Chewable Tabs:

200 mg/28.5 mg

400 mg/57 mg

Oral Susp:

200 mg/28.5 mg/5 mL

400 mg/57 mg/5 mL

Children: 40-45 mg amoxicillin component/kg/day (max 1600 mg/day) in divided doses two or three times daily for 10-14 days.

Q12H using 200 mg/5 mL susp

@ 45 mg/kg/day

9 kg (20 lb) = 1 tsp (5 mL) Q12H

13 kg (29 lb) = 1½ tsp (7.5 mL) Q12H

18 kg (40 lb) = 2 tsp (10 mL) Q12H

Q12H using 400 mg/5 mL susp

@ 45 mg/kg/day

18 kg (40 lb) = 1 tsp (5 mL) Q12H

27 kg (59 lb) = 1½ tsp (7.5 mL) Q12H

35 kg (77 lb) = 2 tsp (10 mL) Q12H

>40 kg = Use adult dose (max 875 mg Q12H).

Adult: 500-875 mg twice daily for 10-14 days.

Food: Take with food to reduce diarrhea.

Important side effects: Diarrhea (common), nausea, rash.

Use with caution in hepatic disease.

Reduce dose in renal disease

(CrCl <30 mL/min).

Clindamycin*

(Cleocin^®)

Generics available

Pregnancy: B; Lactation: Unk

Caps: 75 mg, 150 mg, 300 mg

Oral Solution: 75 mg/5 mL

Children: 10-15 mg/kg/day (max 1.8 g/day) in divided doses PO three or four 10-14 days.

10 mg/kg/day divided Q8H @ 75 mg/5 mL

10 kg (22 lb) = ½ tsp (2.5 mL) Q8H

20 kg (44 lb) = 1 tsp (5 mL) Q8H

30 kg (66 lb) = 1½ tsp (7.5 mL) Q8H

40 kg (88 lb) = 2 tsp (10 mL) Q8H

>40 kg = Use adult dose.

Adult: 150-300 mg PO four times daily for 10-14 days.

Food: May take with or without meals. Take with full glass of water to prevent esophagitis.

Important side effects: Diarrhea, may be severe. Nausea and esophagitis.

*May cause severe colitis. Encourage patient to report severe, persistent, or bloody diarrhea.