From the Guidelines
For mild preseptal orbital cellulitis, Augmentin (amoxicillin-clavulanate) should be prescribed at a dose of 875 mg/125 mg orally twice daily for adults, or 45 mg/kg/day divided into two doses for children, typically for 7-10 days. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of appropriate oral antibiotic therapy for mild cases of preseptal cellulitis 1. The use of high-dose amoxicillin-clavulanate is recommended for comprehensive coverage of common causative organisms, including Staphylococcus aureus, Streptococcus species, and anaerobes that may be involved in preseptal infections.
Key Considerations
- The addition of clavulanic acid helps overcome beta-lactamase resistance, making Augmentin an effective choice for treating preseptal orbital cellulitis 1.
- Patients should complete the full course of antibiotics even if symptoms improve before completion, and it's essential to ensure adequate hydration while taking the medication and to take it with food to minimize gastrointestinal side effects.
- If there's no improvement within 24-48 hours, or if symptoms worsen with vision changes, increased pain, or proptosis, immediate medical reevaluation is necessary as this may indicate progression to orbital cellulitis, which requires more aggressive management including possible hospitalization for intravenous antibiotics 1.
- A 5-day course of antimicrobial therapy may be as effective as a 10-day course if clinical improvement has occurred by 5 days, but this should be determined on a case-by-case basis, considering the severity of the infection and the patient's response to treatment 1.
From the FDA Drug Label
2.1 Adults The usual adult dose is one 500 mg/125 mg amoxicillin and clavulanate potassium tablet every 12 hours or one 250 mg/125 mg amoxicillin and clavulanate potassium tablet every 8 hours For more severe infections and infections of the respiratory tract, the dose should be one 875 mg/125 mg amoxicillin and clavulanate potassium tablet every 12 hours or one 500 mg/125 mg amoxicillin and clavulanate potassium tablet every 8 hours.
The FDA drug label does not answer the question.
From the Research
Treatment of Mild Preseptal Orbital Cellulitis
The treatment of mild preseptal orbital cellulitis typically involves the use of antibiotics.
- The choice of antibiotic is important, with common options including:
- Ampicillin-sulbactam
- Ceftriaxone
- Metronidazole
- Clindamycin
- Amoxicillin
- Amoxicillin-clavulanate (also known as Augmentin) 2
- Vancomycin
- Augmentin (amoxicillin-clavulanate) is often used to treat preseptal and orbital cellulitis, as it is effective against a wide range of bacteria, including those that commonly cause these infections 3
- The dosage and duration of antibiotic treatment will depend on the severity of the infection and the patient's response to treatment, with durations of approximately 2 weeks becoming more common 2
Key Considerations
- It is essential to dose antibiotics to optimize their pharmacodynamic target attainment 2
- Antimicrobial stewardship programs can help guide the choice of antibiotic, dosage, and duration of treatment 2
- Treatment can often be transitioned from intravenous to oral therapy when there are clear signs of clinical and laboratory improvement 2