From the FDA Drug Label
Adults: Serious infections – 150 to 300 mg every 6 hours. More severe infections – 300 to 450 mg every 6 hours Pediatric Patients (for children who are able to swallow capsules): Serious infections – 8 to 16 mg/kg/day (4 to 8 mg/lb/day) divided into three or four equal doses. More severe infections – 16 to 20 mg/kg/day (8 to 10 mg/lb/day) divided into three or four equal doses. The treatment for preseptal cellulitis may include clindamycin. The dosage is as follows:
- Adults: 150 to 300 mg every 6 hours for serious infections, and 300 to 450 mg every 6 hours for more severe infections.
- Pediatric Patients: 8 to 16 mg/kg/day divided into three or four equal doses for serious infections, and 16 to 20 mg/kg/day divided into three or four equal doses for more severe infections 1.
From the Research
Preseptal cellulitis should be treated with antibiotics targeting common causative organisms, with a focus on minimizing broad-spectrum use and optimizing pharmacodynamic target attainment, as recommended in the most recent study 2. The treatment of preseptal cellulitis typically involves antibiotics such as ampicillin-sulbactam, ceftriaxone, metronidazole, clindamycin, amoxicillin, amoxicillin-clavulanate, cefuroxime, and vancomycin, as noted in 3. Key considerations in the management of preseptal cellulitis include:
- The choice of antibiotic, with a focus on targeting the most common pathogens, as discussed in 4
- The importance of dosing antibiotics to optimize their pharmacodynamic target attainment, as highlighted in 3
- The potential for transitioning from initial intravenous therapy to an oral regimen when there are clear signs of clinical and laboratory improvement, as mentioned in 3
- The role of antimicrobial stewardship programs in creating pathways, choosing optimal antibiotics and dosage, and providing the shortest effective durations, as emphasized in 3
- The need for close monitoring of patients for improvement within 24-48 hours, as worsening symptoms may indicate progression to orbital cellulitis, which is a medical emergency, as noted in the example answers.
In terms of specific antibiotic regimens, the most recent study 2 suggests that the use of broad-spectrum antibiotics, including dual/triple therapy and MRSA active antibiotics, can be decreased after the implementation of a clinical practice guideline. Some key points to consider in the treatment of preseptal cellulitis include:
- The use of oral antibiotics such as amoxicillin-clavulanate or cephalexin for mild to moderate cases, as recommended in the example answers
- The need for hospitalization and intravenous antibiotics for severe cases or those with systemic symptoms, as noted in the example answers
- The importance of addressing underlying causes such as sinusitis, trauma, or insect bites to prevent recurrence, as mentioned in the example answers.