Amoxicillin Dosage for Pediatric Preseptal Cellulitis
For pediatric preseptal cellulitis, amoxicillin should be dosed at 45 mg/kg/day divided into 3 doses or 90 mg/kg/day divided into 2 doses. 1, 2
Dosing Recommendations
First-line Therapy
- For mild to moderate preseptal cellulitis:
Alternative Regimens (if penicillin-resistant organisms suspected)
- Amoxicillin-clavulanate: 45 mg/kg/day (of amoxicillin component) in 3 divided doses or 90 mg/kg/day in 2 divided doses 1
- For β-lactamase producing organisms: amoxicillin-clavulanate is preferred 1
Duration of Therapy
- 7-10 days total course is recommended 2
- Treatment should continue for at least 48-72 hours beyond resolution of symptoms 2
Special Considerations
Age-specific Dosing
- For infants less than 12 weeks (3 months): maximum dose should not exceed 30 mg/kg/day divided every 12 hours due to immature renal function 2
- For children ≥3 months: standard dosing applies 2
Renal Impairment Adjustments
- For GFR 10-30 mL/min: reduce dose to 250-500 mg every 12 hours 2
- For GFR <10 mL/min: reduce dose to 250-500 mg every 24 hours 2
Clinical Approach to Preseptal Cellulitis
Common Pathogens to Target
- In children <3 years with URI symptoms: Haemophilus influenzae coverage is important 3
- In children with trauma, insect bites, or skin lesions: Staphylococcus and Streptococcus species are common pathogens 3
When to Consider Alternative Therapy
- If sinusitis is the underlying cause (occurs in approximately 40-53% of cases), broader coverage may be needed 4, 5
- For severe infections or poor response to oral therapy, consider hospitalization for IV antibiotics 4, 6
Warning Signs for Orbital Involvement
- Proptosis, limited eye movement, vision changes, or severe pain with eye movement require immediate evaluation for orbital cellulitis and more aggressive therapy 5
- Fever, leukocytosis, and photophobia are more common with orbital than preseptal cellulitis 5
Monitoring
- Clinical improvement should be seen within 48-72 hours of starting appropriate therapy 2
- If no improvement occurs within this timeframe, reevaluation and possible change in antibiotic therapy is warranted 1
Remember that preseptal cellulitis, while generally having a good prognosis, can rapidly progress to orbital cellulitis if not treated appropriately, which carries risk of vision loss and intracranial complications 4.