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How to manage an infection in the umbilicus of a child?

Q: My daughter when five months old had an infection in her navel. The whole area around the navel had swollen. The doctor diagnosed that it was due to the umbilical hernia. When consulted with the doctor she was administered with cefotaxime and gentamicin I.V. As a result after 7 days the skin below the navel ruptured and all the pus came out of the small ruptured hole. The doctor had prescribed Bactroban (Mupirocin) ointment application on the affected area. We have continued with this application till date (i.e. for about 50 days) but still there is some watery discharge through the hole. A few days back the swab culture of the discharge was done and it was found that there is moderate growth of coagulase negative staphylococci which is sensitive to gentamicin, ciprofloxacin and suprafloxacin. The doctor has told that ciprofloxacin and suprafloxacin cannot be advised as they are recommended for children above 12 years and gentamicin is available as injection only. Is mupirocin effective against coagulase negative staphylococci? Please advise some other medicine if it is not effective? Also note that that the umbilical cord of my daughter fell within 4 days of her birth and her navel was also bulging outwards. When the navel was pressed by a finger there was sound as if some air is come out.

A:There is a lot of discrepancy in what you have written. From the last sentence it appears that your baby had an umbilical hernia. These DO NOT burst or get infected discharging pus the way you describe. Sometimes there are umbilical remnants that do get infected and the treatment for them is by an operation. Since this problem has gone on a long time, continued antibiotic use is not recommended. You should quickly see a good paediatric surgeon in your town who will assess and advise accordingly. Please treat this as a priority.

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