From the Research
For preseptal orbital cellulitis, the best oral antibiotic is typically amoxicillin-clavulanate (Augmentin), as it provides coverage against the most common causative organisms, including Staphylococcus aureus, Streptococcus species, and Haemophilus influenzae. The recommended adult dosage is 875 mg/125 mg twice daily for 7-10 days, while children should receive 45 mg/kg/day divided into two doses 1. This recommendation is based on the most recent and highest quality study, which emphasizes the importance of optimizing pharmacodynamic target attainment and antimicrobial stewardship in the treatment of orbital and preseptal cellulitis 1.
Key Considerations
- The choice of antibiotic should be guided by the suspected causative organisms and their likely antibiotic susceptibility patterns 2.
- Patients with penicillin allergies may require alternative antibiotics, such as clindamycin (300-450 mg four times daily for adults) or trimethoprim-sulfamethoxazole plus either cefpodoxime or cefdinir.
- Treatment should be accompanied by warm compresses applied to the affected area 3-4 times daily.
- Patients should be monitored closely for signs of progression to orbital cellulitis, which would require immediate hospitalization for intravenous antibiotics 3.
Monitoring and Follow-up
- Patients should be reevaluated promptly if symptoms do not improve within 48-72 hours of oral therapy, or if they worsen at any point, as they may need more aggressive treatment 1.
- The total duration of therapy for these infections has been decreasing in recent years, with durations of approximately 2 weeks becoming more common, even for orbital or subperiosteal infections 1.