From the Guidelines
Preseptal cellulitis should be treated with antibiotics that target common causative organisms like Staphylococcus aureus and Streptococcus species, with a recommended duration of antimicrobial therapy of 5 days, but treatment should be extended if the infection has not improved within this time period 1. For mild to moderate cases in adults, oral antibiotics such as amoxicillin-clavulanate or trimethoprim-sulfamethoxazole are recommended.
- Amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days)
- Trimethoprim-sulfamethoxazole (1-2 DS tablets twice daily for 7-10 days) Children may receive amoxicillin-clavulanate (45 mg/kg/day divided twice daily) or cefdinir (14 mg/kg/day divided twice daily). Severe cases, patients with systemic symptoms, or those under 1 year old require hospitalization for intravenous antibiotics like ampicillin-sulbactam or ceftriaxone plus vancomycin if MRSA is suspected. Treatment should be accompanied by warm compresses to reduce inflammation and elevation of the affected area to reduce swelling 1. Patients should be monitored for orbital involvement (eye pain, vision changes, limited eye movement), which represents progression to the more serious orbital cellulitis requiring immediate ophthalmology consultation. In some cases, systemic corticosteroids (eg, prednisone 40 mg daily for 7 days) could be considered in nondiabetic adult patients with cellulitis 1. Preseptal cellulitis must be treated promptly as the infection can spread posteriorly through the orbital septum, potentially leading to vision-threatening complications. Outpatient therapy is recommended for patients who do not have SIRS, altered mental status, or hemodynamic instability, while hospitalization is recommended if there is concern for a deeper or necrotizing infection, for patients with poor adherence to therapy, for infection in a severely immunocompromised patient 1.
From the Research
Treatment Options for Preseptal Cellulitis
- Antibiotics are commonly used to treat preseptal cellulitis, with options including ampicillin-sulbactam, ceftriaxone, metronidazole, clindamycin, amoxicillin, amoxicillin-clavulanate, cefuroxime, and vancomycin 2
- The choice of antibiotic should be based on the suspected causative organism and the patient's clinical presentation
- Antibiotics can be administered intravenously or orally, with the option to transition from intravenous to oral therapy when there are clear signs of clinical and laboratory improvement 2
Ambulatory Intravenous Antibiotic Therapy
- Ambulatory intravenous antibiotic therapy can be a safe and cost-effective alternative to inpatient admission for children with preseptal cellulitis who require parenteral antibiotics 3
- This approach can reduce the duration of hospital stay and decrease healthcare costs
- Daily review and monitoring are essential to ensure the patient's condition is improving and to adjust the treatment plan as needed 3
Clinical Practice Guidelines
- Implementing clinical practice guidelines (CPGs) can improve antibiotic use and resource utilization for pediatric preseptal cellulitis 4
- CPGs can help reduce the use of broad-spectrum antibiotics and decrease the number of blood tests and imaging studies ordered
- Education and buy-in from healthcare providers are crucial for successful implementation of CPGs 4
Management Strategies
- Rapid diagnosis and prompt initiation of therapy are essential in minimizing complications and optimizing outcomes for preseptal cellulitis 5
- Anatomic considerations, predisposing conditions, and approaches to evaluation should be taken into account when developing a management strategy
- Close monitoring and follow-up are necessary to ensure the patient's condition is improving and to adjust the treatment plan as needed 5