To refer a patient to Connecticut Children’s, contact the OneCall team:

Skin and Soft Tissue Infection

Pathway Background and Objectives

Over the years, the increase in resistance to typical antibiotics has changed the approach to the management of skin and soft tissue infections (SSTIs) in children.  In 2014, the Infectious Disease Society of America (IDSA) updated their SSTIs guidelines.  Based on these changes and also our local antimicrobial data, we have applied these recommendations to provide a consistent approach to treatment of children with these infections.

The specific objectives of this pathway are to:

  • Outline the management of SSTIs depending on severity of infection
  • Recommend tailored antibiotic therapy based on culture results
  • Recommend oral options for intravenous antibiotics


Download Skin and Soft Tissue Infection Pathway Algorithm Updated February 12, 2021

Attention: There is currently a shortage of intravenous (IV) clindamycin

In the event of a shortage at your institution, Connecticut Children’s Infectious Diseases and Immunology and Antimicrobial Stewardship Program suggest the following alternatives:

  • If your patient is able to effectively take oral medications, it is recommended to simply substitute with oral clindamycin at a similar dose, as oral clindamycin has very high bioavailability (i.e., > 90%).
  • For a purulent infection (i.e., carbuncle, furuncle, abscess):
    • If drained: consider sulfamethoxazole/trimethoprim
    • If undrained: consider doxycycline

If you have any questions on further alternatives or appropriateness of antibiotics, please call our Infectious Diseases and Immunology Department through the One Call Hotline at 1-833-PEDS-NOW to be connected with the On-Call physician.

Quality Metrics

  • Percentage of eligible patients with SSTI order set usage (for admitted patients only)
  • Percentage of patients who receive the recommended antibiotics per pathway
  • Percentage of patients who receive the appropriate dosage of antibiotics per pathway
  • Percentage of patients prescribed 5-10 total course of antibiotic therapy
  • Average length of stay (days) for patients admitted with SSTI
  • Percentage of patients readmitted within 7 days of discharge

Educational Module

Download Skin and Soft Tissue Infection Educational Module Updated February 12, 2021 

Key References

Stevens DL, Bisno AL, Chambers HF, et al.  Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul;59(2):e10-52.

Pathway Contacts

Grace Hong, APRN
Jennifer Girotto, PharmD


The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.

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