{ "schema_version": 1, "kind": "condition", "id": "staphylococcal-scalded-skin-syndrome", "name": "Staphylococcal scalded skin syndrome", "category": "emergency", "sources": "Staphylococcal Scalded Skin Syndrome - StatPearls (NCBI Bookshelf NBK448135) - https://www.ncbi.nlm.nih.gov/books/NBK448135/ · Staphylococcal scalded skin syndrome - disease-level clinical article (staphylococcal-scalded-skin-syndrome-full.txt) · Staphylococcal scalded skin syndrome - disease-level clinical article (staphylococcal-scalded-skin-syndrome-clinical.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (cefazolin monograph, p216) · Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219)", "review_status": "reviewed", "verified_against": "Staphylococcal Scalded Skin Syndrome - StatPearls (NCBI Bookshelf NBK448135) - https://www.ncbi.nlm.nih.gov/books/NBK448135/ · Staphylococcal scalded skin syndrome - disease-level clinical article (staphylococcal-scalded-skin-syndrome-full.txt) · Staphylococcal scalded skin syndrome - disease-level clinical article (staphylococcal-scalded-skin-syndrome-clinical.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (cefazolin monograph, p216) · Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219)", "verified_date": "2026-08", "treatments": [ { "id": 1726, "generic": "Cefazolin", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": 500.0, "adult_dose": "1-2 g every 8 hours intravenously", "adult_duration": "10 days unless the clinical picture calls for longer", "dose_source": "Staphylococcal Scalded Skin Syndrome - StatPearls (NCBI Bookshelf NBK448135) - https://www.ncbi.nlm.nih.gov/books/NBK448135/", "rationale": "The cited article says an antibiotic active against methicillin-sensitive Staphylococcus aureus should be given promptly, and gives cefazolin at 50 to 100 mg/kg daily divided every 8 hours in children. The Egyptian formulary's cefazolin monograph names skin and soft tissue infection among its indications but carries no paediatric section, so the child's dose is cited to the article and the indication to the formulary. Nafcillin and oxacillin, the article's other two choices at 100-150 mg/kg daily, are not in the Egyptian formulary.", "cautions": [ "A CHILD WITH WIDESPREAD SKIN LOSS BELONGS IN HOSPITAL. The article says severe generalised disease needs admission and intravenous antibiotics, sometimes intensive care, for fluid loss and hypothermia through the raw skin - the same problem as a burn.", "IF MRSA IS SUSPECTED, THIS DRUG WILL NOT COVER IT. The article says give vancomycin instead where there has been recent healthcare contact, recent admission, nursing-home residence, or where local MRSA is common.", "DO NOT USE SILVER SULFADIAZINE ON THE SKIN. The article warns against it here: too much is absorbed through denuded skin and becomes toxic.", "AVOID IBUPROFEN AND THE OTHER NSAIDs for the pain - the article warns of kidney injury in this illness. Paracetamol, and an opioid if needed, are what it names.", "Clindamycin may reduce toxin production, but up to half of the strains behind this illness are clindamycin-resistant, so it is never the drug on its own." ], "peds_mgkg_low": 50.0, "peds_mgkg_high": 100.0, "peds_max_mg": null, "peds_basis": "day", "peds_unit": "mg", "peds_note": "50-100 mg/kg/day divided every 8 hours, intravenously. The article's alternatives, nafcillin or oxacillin at 100-150 mg/kg/day divided every 6 hours, are not stocked in Egypt.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 500, "high_mg": 1000, "capped": false }, { "weight_kg": 20, "low_mg": 1000, "high_mg": 2000, "capped": false }, { "weight_kg": 30, "low_mg": 1500, "high_mg": 3000, "capped": false }, { "weight_kg": 40, "low_mg": 2000, "high_mg": 4000, "capped": false } ], "brands": [ { "trade_name": "ZINOL 500 MG I.M./I.V. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO B", "price_egp": 31.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "staphylococcal-scalded-skin-syndrome" }, { "id": 1728, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Staphylococcal Scalded Skin Syndrome - StatPearls (NCBI Bookshelf NBK448135) - https://www.ncbi.nlm.nih.gov/books/NBK448135/", "rationale": "A febrile child whose skin is peeling in sheets is an admission for intravenous antibiotics and fluid. The article gives paediatric doses only for intravenous drugs, and its oral figures are adult amounts with no age band, so no prescribing row is offered - printing an oral antibiotic here would look like an alternative to hospital, and it is not.", "cautions": [ "SEVERE DISEASE MEANS ADMISSION, NOT AN ORAL SCRIPT - a child with severe, widespread SSSS has to go in for intravenous antibiotics, and intensive care may be needed, since the skin may want saline-soaked gauze and proper wound care. Start antibiotics promptly, aimed at methicillin-sensitive Staphylococcus aureus - cefazolin, nafcillin or oxacillin.", "WHY A CHILD DETERIORATES - the skin is behaving like a burn. Where a lot of it is involved the child loses heat and fluid through the lost epidermis, so hypothermia and a fluid deficit follow. Supportive care is the essential part: dehydration managed, temperature held, nutrition kept up, and intravenous fluid once there are signs of dehydration or of sepsis.", "DO NOT GIVE IBUPROFEN - paracetamol, and an opioid where the pain needs it, are the analgesics here. A non-steroidal anti-inflammatory such as ibuprofen must be AVOIDED, because of the risk to the kidneys. This matters because ibuprofen is the reflex antipyretic for a hot, miserable child, and here it is the wrong one.", "DO NOT PUT SILVER SULFADIAZINE ON IT - silver sulfadiazine must be AVOIDED here: more of it is absorbed through skin in this state, and toxicity follows. It is the standard burns cream and this looks like a burn; say so before someone reaches for it.", "TOPICAL ANTIBIOTICS ARE NOT TREATMENT HERE - a topical antimicrobial is generally ineffective in SSSS, though one may be used to decolonise the primary site of infection. The toxin is circulating; the skin that is peeling is not itself infected.", "CLINDAMYCIN ALONE IS NOT ENOUGH - clindamycin can damp down the toxin the bacteria make, but as many as 50% of the strains behind SSSS are resistant to it, so it must NOT be used on its own.", "SKIN CARE WHILE WAITING FOR TRANSPORT - put emollients and non-adherent dressings on the raw areas, to help them heal and to cut the heat lost. Keep the child warm and keep gauze off raw skin.", "A NEGATIVE SWAB PROVES NOTHING - a blood culture usually tells you little, because what spreads through the blood is the toxin, not the organism. And even where the fluid from an intact bulla grows nothing, S aureus may still be grown from the conjunctiva, the nasopharynx, the perianal skin, or a pus-filled focus elsewhere on the skin. Swab the nose, the eyes and the nappy area, not the blisters. The white cell count may be raised or may be perfectly normal.", "IT IS A CLINICAL DIAGNOSIS - SSSS is diagnosed chiefly on how it looks, with further tests reserved for the occasional case where the diagnosis is genuinely in doubt. Do not wait on a laboratory to start the referral.", "THE OUTLOOK IN A CHILD IS GOOD IF IT IS TREATED - treated properly, SSSS usually clears in 1 to 2 weeks and usually without complications, and a child is generally left with little or no scarring. Mortality in children is 4% or under; in adults it can reach 50%, on account of the illnesses they already carry.", "MILD CASES EXIST, AND THE DOSES FOR THEM ARE NOT PRINTED HERE - the article does say that a milder case is usually served by an oral beta-lactamase-resistant penicillin, or a first-generation cephalosporin, for a week at least. Its weight-based figures are for intravenous drugs, and its oral figures are flat adult amounts with no paediatric equivalent, so nothing here can be turned into a safe paediatric oral dose. Deciding that a child's SSSS is mild enough for oral treatment belongs to whoever admits them.", "PREVENT THE NEXT ONE - hygiene is the prevention, in children and adults alike: washing hands regularly, and looking after wounds properly. Parents and carers should keep the skin clean and watch for any sign of infection, particularly in a child who already has a skin disorder such as eczema. Where the infection was picked up in hospital, finding the S aureus carriers and decontaminating them matters especially." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "staphylococcal-scalded-skin-syndrome" }, { "id": 1727, "generic": "Cephalexin", "line": 2, "is_adjunct": false, "form": "oral.liquid", "strength_mg": 250.0, "adult_dose": "500 mg every 6 hours", "adult_duration": "At least one week", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph, p219)", "rationale": "The cited article says an oral beta-lactamase-resistant penicillin or a first-generation cephalosporin for at least one week is usually enough for milder cases, and names cephalexin at 500 mg every 6 hours as one of the oral alternatives. The formulary's cephalexin monograph names skin and skin structure infection caused by Staphylococcus aureus and Streptococcus pyogenes as an indication and supplies the child's weight-based rule.", "cautions": [ "ORAL TREATMENT IS FOR THE MILD CASE ONLY. If the skin is peeling over a large area, if the child is dehydrated, febrile and miserable, or if there is any doubt, this is an admission, not a prescription.", "Tablets and oral suspension are not bioequivalent - the formulary says they must not be substituted milligram for milligram.", "Do not give to a child with a known allergy to cephalexin, another cephalosporin, or any component of the preparation.", "AVOID IBUPROFEN AND THE OTHER NSAIDs for the pain in this illness; the article warns of kidney injury. Use paracetamol." ], "peds_mgkg_low": 25.0, "peds_mgkg_high": 50.0, "peds_max_mg": 2000.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "Mild to moderate infection: 25-50 mg/kg/day divided every 6 or 12 hours, maximum 2,000 mg/day.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 250, "high_mg": 500, "capped": false }, { "weight_kg": 20, "low_mg": 500, "high_mg": 1000, "capped": false }, { "weight_kg": 30, "low_mg": 750, "high_mg": 1500, "capped": false }, { "weight_kg": 40, "low_mg": 1000, "high_mg": 2000, "capped": false } ], "brands": [ { "trade_name": "AMTHROST 250MG/5ML SUSP. 60ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA > SABAA", "price_egp": 4.5, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEPHOXIN 250MG/5ML DRY SUSP. 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO B", "price_egp": 6.5, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEPHALEXIN 250MG/5ML SUSP. 60ML USP24", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 8.0, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEPHLEX 250 MG/5 ML SUSP. 60ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 10.5, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MEDICEFLEXIN 250MG/5ML SUSP. 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "T3A PHARMA > RIVA PHARMA S.A.E.", "price_egp": 14.25, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "KEFLEX 250MG/5ML PD. FOR ORAL SUSP. 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HIKMA PHARMA", "price_egp": 37.0, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMTHROST 125MG/5ML SUSP. 60ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA > SABAA", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": 125.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "CEPHOXIN 125MG/5ML DRY SUSP. 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO B", "price_egp": 6.0, "pack_count": null, "unit_price": null, "strength_mg": 125.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "staphylococcal-scalded-skin-syndrome" } ] }