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Common Bacterial Infections in Children 97
Evidence-Based Research
Table 15.1 compares the healing effects of honey versus EUSOL, and
Table 15.2 presents evidence-based research on perianal abscess and
fistula-in-ano in children in Zaria, Nigeria.
Table 15.1: Evidence-based research. Table 15.2: Evidence-based research.
Title Comparison of healing of incised abscess wounds with honey Title Perianal abscess and fistula in children in Zaria
and EUSOL dressing
Authors Ameh EA
Authors Okeniyi JA, Olubanjo OO, Ogunlesi TA, Oyelami OA
Institution Paediatric Surgery Unit, Department of Surgery, Ahmadu Bello
Institution Department of Paediatrics and Child Health, Obafemi University Teaching Hospital, Zaria, Nigeria.
Awolowo University, Ile-Ife, Ilesa, Nigeria.
Reference Niger Postgrad Med J 2003; 10(2):107–109.
Reference J Altern Complement Med 2005; 11(3):511–513. Problem Perianal abscess and fistula in ano in African children
Problem Healing of wounds post abscess drainage Comparison/ Perianal abscess (PAA) and fistula-in-ano (FIA) are not
Intervention To clinically compare the healing of abscess wounds dressed control uncommon in children, but reports from tropical Africa are
with either crude undiluted honey or Edinburgh University (quality of uncommon. In a period of 17 years, 17 children aged 12
solution of lime (EUSOL). years and younger were treated for these conditions in Zaria,
evidence) Nigeria. There were 14 boys and 3 girls, aged 4 months to
Comparison/ A prospective clinical randomized study. LOCATION: The 12 years (median age, 3 years), Eight had PAA (median age,
control Isolation Children’s Ward of the Wesley Guild Hospital, 3 years), 5 ischiorectal abscess (median age, 5 years) and
(quality of Ilesa, an affiliate of the Obafemi Awolowo University, Ile-Ife, 4 FIA (median age, 10 months). FIA followed pull through
Nigeria. SUBJECTS: 32 Nigerian children with 43 pyomyositis
evidence) abcesses. INTERVENTIONS: All subjects had fresh surgical for anorectal malformation in two patients, and in one it was
preceded by PAA. PAA was associated with chronic fissure-
incisions and drainage of the abcesses and a 21-day course in-ano in one patient and uncontrolled diabetes mellitus in
of ampicillin plus cloxacillin (Ampiclox) and gentamicin; the one. One 16-month-old girl with an ischiorectal abscess
wounds were left to close spontaneously with twice-daily developed severe perineal necrotising fascitis and separation
wound dressing with packing of the abscess cavity with either and retraction of the anorectum. Escherichia coli was
honey- or EUSOL-soaked gauze in two randomized treatment cultured in two patients with abscesses, and Staphylococcus
groups. OUTCOME MEASURES: The clinical conditions of the aureus in another two. Culture was sterile in seven patients
wound sites were documented on days 1, 3, 7, and 21 as either with abscesses. Treatment was by adequate incision and
clean or dirty, dry or wet, granulation tissue present or absent, drainage for abscesses. Fistulectomy was the treatment for
and epithelialisation present or absent. The length of hospital FIA, but in one patient a diversion colostomy was performed
stay was also measured. RESULTS: Honey-treated wounds in addition, as the fistula was a high one. The child who
demonstrated quicker healing, and the length of hospital stay developed necrotising fascitis had debridement and a
was significantly shorter in patients with honey-treated wounds diversion colostomy. FIA recurred in one patient, necessitating
than those treated with EUSOL (t = 2.45, p = 0.019). repeat fistulectomy. Although the number of patients is small,
Outcome/ Honey is a superior wound dressing agent compared to perianal sepsis appears to be less common in the Tropical
effect EUSOL. Honey is recommended for the dressing of infected African environment compared to developed countries. Some
wounds, even more so in tropical countries, where it is most differences are highlighted.
readily available.

Key Summary Points
1. Bacterial infections are the cause of significant mortality and 4. Bacterial infections are more common at extreme of ages,
morbidity in children. and thus babies younger than 2 months of age are highly
susceptible to acquire bacterial infection.
2. Infections of surgical importance may affect virtually any organ
or tissue in the body. 5. Other conditions such as malnutrition, immune-deficiency
states, and prolonged illnesses make the children more
3. Infections may be community or hospital acquired. susceptible to acquire infections.

Suggested Reading

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(myositis tropicans): current perspective. Postgrad Med J 2004; abscess in children. Pediatr Dev Pathol 1999; 2(6):537–543.
80(943):267–270.
Steer AC, Danchin MH, Carapetis JR. Group A streptococcal
Cole C, Gazewood J. Diagnosis and treatment of impetigo. Am Fam infections in children. J. Paediatr Child Health 2007; 43(4):
Physician 2007; 75(6):859–864. 203–213.
Jain SK, Persaud D, Perl TM, et al. Nosocomial malaria and saline Swiss NOSO. Swiss Hand Hygiene Campaign, fact sheet. Available
flush. Emerg Infect Dis 2005; 11(7): 1097–1099.. at www.swisshandhygiene.ch and www.swiss-noso.ch. Accessed
5 October 2009.
Legbo JN, Legbo JF. Bacterial isolates from necrotizing fasciitis: a
clinico-pathological perspective. Niger J Med 2007; 16(2):143–147.
Moazam F, Nazir Z. Amebic liver abscess: spare the knife but save
the child. J Pediatr Surg 1998; 33(1):119–122.