From the Research
The recommended management for preseptal cellulitis typically involves oral antibiotics that cover common causative organisms like Staphylococcus aureus and Streptococcus species. First-line treatment for adults is amoxicillin-clavulanate 875/125 mg twice daily for 7-10 days, as supported by the most recent and highest quality studies available 1, 2. Alternatives include cephalexin 500 mg four times daily or clindamycin 300-450 mg four times daily for patients with penicillin allergies. For children, amoxicillin-clavulanate 45 mg/kg/day divided twice daily is appropriate, with weight-adjusted dosing of alternatives if needed. Some studies suggest the use of sulbactam-ampicillin as a safe and effective choice of treatment in orbital and preseptal cellulitis 3. However, the most recent study from 2011 1 highlights the emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) as a causative organism, indicating the need for modifying empirical antimicrobial therapy. Warm compresses applied to the affected area for 15 minutes several times daily can help reduce inflammation. Patients should be monitored for signs of progression, including increasing pain, vision changes, or restricted eye movement, which may indicate spread to orbital cellulitis requiring immediate hospitalization and IV antibiotics. Most cases of preseptal cellulitis resolve within a week with appropriate treatment, as seen in studies 4, 2. This approach targets the bacterial infection while preventing spread to the orbital tissues, which would be a more serious condition requiring more aggressive management. Key considerations in management include:
- Identifying the causative organism to guide antibiotic therapy
- Monitoring for signs of progression to orbital cellulitis
- Using oral antibiotics as first-line treatment for preseptal cellulitis
- Considering alternative treatments, such as sulbactam-ampicillin, in certain cases
- Applying warm compresses to reduce inflammation
- Adjusting treatment based on patient response and potential complications.