From the Guidelines
For bilateral periorbital cellulitis and facial cellulitis upon discharge from the emergency department, I recommend amoxicillin-clavulanate (Augmentin) as the first-line antibiotic, with a dosage of 875/125 mg twice daily for 5-6 days for adults, and 45 mg/kg/day divided twice daily (based on the amoxicillin component) for the same duration for children. This recommendation is based on the most recent guidelines from the American College of Physicians, which suggest that a 5- to 6-day course of antibiotics active against streptococci is sufficient for nonpurulent cellulitis, particularly for patients able to self-monitor and who have close follow-up with primary care 1. The choice of amoxicillin-clavulanate is due to its coverage against common causative organisms including Staphylococcus aureus, Streptococcus species, and anaerobes. For patients with penicillin allergy, alternatives include clindamycin (300-450 mg orally four times daily for adults; 30-40 mg/kg/day divided three times daily for children) or trimethoprim-sulfamethoxazole plus cephalexin. It is crucial for patients to be instructed to return immediately if symptoms worsen, particularly if there is increasing eye pain, vision changes, restricted eye movement, or worsening swelling, as these may indicate progression to orbital cellulitis requiring intravenous antibiotics. Close follow-up within 24-48 hours is essential to ensure improvement, and the full course of antibiotics should be completed even if symptoms resolve earlier, as supported by the guidelines from the Infectious Diseases Society of America 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Antibiotic Treatment for Bilateral Periorbital Cellulitis and Facial Cellulitis
- The most commonly used antibiotic for periorbital cellulitis is amoxicillin-clavulanic acid 2.
- Sulbactam-ampicillin (SAM) with or without ornidazole can be used as a first-line treatment for periorbital cellulitis, with a duration of treatment between 7 and 10 days 3.
- For facial cellulitis, penicillin or penicillinase-resistant penicillin alone or in combination can be effective, with a cure rate of 68% 4.
- The duration of antibiotic treatment for cellulitis can vary, but there is no evidence of difference in clinical response rates for shorter or longer durations 5.
Dosage and Duration
- The dosage and duration of antibiotic treatment for bilateral periorbital cellulitis and facial cellulitis are not explicitly stated in the studies, but the following can be inferred:
- Amoxicillin-clavulanic acid: no specific dosage mentioned 2.
- Sulbactam-ampicillin (SAM): duration of treatment between 7 and 10 days 3.
- Penicillin or penicillinase-resistant penicillin: duration of treatment not specified, but supplementary clindamycin was used for 1-3 days in some cases 4.
Considerations
- The choice of antibiotic and duration of treatment should be based on the severity of the infection, the presence of underlying conditions, and the patient's response to treatment 6.
- It is essential to search for an underlying source of infection and to provide broad initial coverage with antibiotics due to the wide variety of infecting organisms 6.