Preseptal Cellulitis Medication

Updated: Mar 10, 2021
  • Author: Mounir Bashour, MD, PhD, CM, FRCSC, FACS; Chief Editor: Edsel B Ing, MD, MPH, FRCSC, PhD, MA  more...
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Medication

Medication Summary

Medications used in the treatment of preseptal cellulitis include the following:

  • Amoxicillin/clavulanic acid or intramuscular ceftriaxone - Considered for outpatient treatment in selected patients

  • Second- or third-generation cephalosporins - Possible choice for initial empiric therapy

  • Penicillinase-resistant synthetic penicillin (eg, nafcillin, oxacillin) - If S aureus is suspected

For patients on IV antibiotics, clinical improvement after 48-72 hours of IV administration means that a 24-hour trial of oral antibiotics can be employed.

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Antibiotics, Other

Class Summary

Antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Amoxicillin and clavulanate (Augmentin, Amoclan, Augmentin XR)

Amoxicillin is a third-generation aminopenicillin. Combined with the beta-lactam clavulanic acid, it is less susceptible to degradation by beta-lactamases produced by microorganisms.

Ceftriaxone (Rocephin)

Ceftriaxone is a third-generation cephalosporin with broad-spectrum, gram-negative activity. It has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. Ceftriaxone arrests bacterial growth by binding to 1 or more penicillin-binding proteins.

Clindamycin (Cleocin, Cleocin Pediatric, ClindaMax Vaginal)

Clindamycin is a semisynthetic antibiotic produced by a 7(S)-chloro-substitution of the 7(R)-hydroxyl group of the parent compound lincomycin.

Nafcillin

Nafcillin, a second-generation penicillinase penicillin, is used for suspected penicillin G-resistant streptococcal or staphylococcal infections. In severe infections, it should initially be used parenterally, with a change to oral therapy as the condition warrants.

Due to thrombophlebitis, particularly in elderly persons, administer nafcillin parenterally for only a short term (1-2d); change to the oral route as clinically indicated.

Cephalexin (Keflex)

Cephalexin is a first-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell wall synthesis. It has bactericidal activity against rapidly growing organisms. Cephalexin's primary activity is against skin flora. Cephalexin is used for skin infections or prophylaxis in minor procedures.

Oxacillin

Oxacillin is a bactericidal antibiotic that inhibits cell wall synthesis. It is used in the treatment of infections caused by penicillinase-producing staphylococci. It may be used to initiate therapy when a staphylococcal infection is suspected.

Cefuroxime (Ceftin, Zinacef)

Cefuroxime is a second-generation oral cephalosporin antibiotic that inhibits cell wall synthesis and is bactericidal.

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