Amoxicillin Dosing for Preseptal Cellulitis in a 1 Year 10 Month Old Child
For a 1 year 10 month old child with preseptal cellulitis, prescribe amoxicillin-clavulanate (Augmentin) at 45 mg/kg/day of the amoxicillin component divided every 12 hours for 7-10 days. 1, 2
Rationale for Amoxicillin-Clavulanate Over Amoxicillin Alone
While the question asks specifically about amoxicillin, preseptal cellulitis requires coverage for beta-lactamase producing organisms (particularly Haemophilus influenzae and Staphylococcus aureus), making amoxicillin-clavulanate the preferred agent rather than amoxicillin alone. 3, 4
- Recent studies demonstrate that amoxicillin-clavulanate is the most commonly used antibiotic for preseptal cellulitis in children, with excellent outcomes. 3
- The combination provides necessary coverage against the polymicrobial nature of preseptal cellulitis, which frequently involves beta-lactamase producing organisms. 4
Specific Dosing Calculation
For standard dosing:
- Use 45 mg/kg/day of the amoxicillin component divided into 2 doses (every 12 hours). 1, 5
- This translates to approximately 22.5 mg/kg per dose given twice daily. 1
For severe infections or high-resistance areas:
- Consider 90 mg/kg/day of the amoxicillin component divided into 2 doses. 1, 2
- Maximum daily dose should not exceed 4000 mg of amoxicillin component. 1
Treatment Duration
- Standard duration is 7-10 days for skin and soft tissue infections including preseptal cellulitis. 1, 2
- Continue treatment for a minimum of 48-72 hours beyond clinical improvement. 1, 5
Clinical Monitoring
Children should demonstrate clinical improvement within 48-72 hours of appropriate therapy. 1, 2
- If no improvement occurs within this timeframe, reevaluation is mandatory and imaging (CT scan) should be considered to rule out progression to orbital cellulitis or abscess formation. 3, 6
- Monitor for common adverse effects including diarrhea (more common with three-times-daily dosing), nausea, vomiting, and rash. 2, 4
Critical Pitfalls to Avoid
Do not use amoxicillin alone for preseptal cellulitis, as it lacks coverage for beta-lactamase producing organisms that are common causative pathogens. 4
- Check for penicillin allergy history before prescribing; if present, alternative antibiotics such as clindamycin should be considered. 2, 6
- Ensure adequate dosing based on current weight, as underdosing may lead to treatment failure and progression to orbital cellulitis. 3
- Do not prescribe the 875 mg tablet formulation for children under 40 kg; use the oral suspension instead. 5
Administration Instructions
- Administer at the start of meals to minimize gastrointestinal intolerance. 5
- The suspension can be mixed with formula, milk, fruit juice, or water if needed, but must be taken immediately after mixing. 5
- Shake the suspension well before each use and refrigerate after reconstitution (though not required). 5
- Discard any unused suspension after 14 days. 5