What is the recommended dose of Augmentin (amoxicillin-clavulanate) for treating periorbital cellulitis?

Augmentin Dosing for Periorbital Cellulitis

Recommended Dosing

For periorbital cellulitis, the recommended dose of Augmentin (amoxicillin-clavulanate) is high-dose amoxicillin-clavulanate at 875 mg/125 mg tablets every 12 hours for adults, and 90 mg/kg/day of the amoxicillin component divided into two doses for children. 1, 2

Adult Dosing

• For adults with periorbital cellulitis, prescribe 875 mg/125 mg tablets every 12 hours (equivalent to 1750 mg amoxicillin and 250 mg clavulanate daily) 2
• For more severe infections, the dose should remain at 875 mg/125 mg every 12 hours 2
• Treatment duration should typically be 5-10 days, based on clinical response 1

Pediatric Dosing

• For children with periorbital cellulitis, prescribe high-dose amoxicillin-clavulanate at 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate divided into two doses 1
• Children weighing 40 kg or more should be dosed according to adult recommendations 2
• Treatment duration for children is typically 10-14 days 1

Rationale for Amoxicillin-Clavulanate Selection

• Amoxicillin-clavulanate is preferred over amoxicillin alone for periorbital cellulitis due to better coverage against β-lactamase-producing organisms, including Streptococcus species and Staphylococcus aureus 1
• Staphylococcus aureus is a common pathogen in periorbital cellulitis, isolated in up to 74% of positive cultures 3
• High-dose formulation overcomes potential resistance in common pathogens 1
• Sinusitis is the most common cause of periorbital cellulitis (43% of cases), and amoxicillin-clavulanate provides appropriate coverage for sinus pathogens 3, 4

Administration Guidelines

• Augmentin should be taken at the start of a meal to minimize gastrointestinal intolerance and enhance absorption of clavulanate 2
• For patients who have difficulty swallowing tablets, appropriate suspension formulations can be used 2
• Two 250 mg/125 mg tablets should not be substituted for one 500 mg/125 mg tablet due to different amounts of clavulanic acid 2

Monitoring and Follow-up

• Daily follow-up is recommended until definite improvement is noted for outpatients 1
• If no improvement occurs within 24-48 hours or if infection is progressive, consider hospitalization for intravenous antibiotics 1
• For patients with signs of orbital involvement (proptosis, impaired visual acuity, or impaired/painful extraocular mobility), immediate hospitalization and intravenous antibiotics are necessary 1

Alternative Regimens

• If the patient does not improve within 72 hours, consider switching to alternative antibiotics such as clindamycin plus cefixime, linezolid plus cefixime, or levofloxacin 1
• For patients with MRSA concerns who don't respond to initial therapy, options include clindamycin, trimethoprim-sulfamethoxazole, doxycycline, or linezolid 1
• In a hospital setting, intravenous ceftriaxone with metronidazole has been associated with shorter hospital stays (3.8 days) compared to ceftriaxone alone (5.8 days) or co-amoxiclav (4.5 days) 5

Important Considerations and Pitfalls

• Avoid first-generation cephalosporins like cephalexin as they may be ineffective for this condition 1
• Prior treatment with non-steroidal anti-inflammatory drugs may be associated with complications and should be noted in patient history 4
• Complications of periorbital cellulitis can include progression to orbital cellulitis, which may lead to permanent blindness if not treated promptly 1
• Intranasal decongestants and corticosteroids may reduce the requirement for surgical intervention 5
• Preseptal cellulitis has a better prognosis than orbital cellulitis, with mean hospital stays of 3 days versus 8 days respectively 4