Periorbital/Preseptal Cellulitis

Periorbital/preseptal cellulitis, suspected to be caused by skin flora (most common) 

Group A streptococcus 

Staphylococcus aureus 

Cephalexin
25 mg/kg/dose (max 500 mg/dose) enterally tid  

OR 

Cefazolin
25 mg/kg/dose (max 1000 mg/dose) IV q8h  

Choice of IV vs. enteral depending on illness severity; switch to enteral upon clinical improvement 

Penicillin or cephalosporin allergy with higher risk for allergic reaction:  

Clindamycin
10 mg/kg/dose (max 900 mg/dose) IV q8h  

OR  

Clindamycin
10 mg/kg/dose (max 600 mg/dose) enterally tid 

If patient is ill enough for inpatient care, consider evaluation for Orbital Cellulitis/Abscess, consider Ophthalmology consult 

Duration: 5-7 days or until resolution of inflammation 

Periorbital/preseptal cellulitis, suspected to be caused by sinus flora (patient has associated symptoms of sinusitis)  

Include coverage for:  

Streptococci 

Anaerobes 

Amoxicillin-clavulanate (Augmentin)
45 mg amoxicillin/kg/ dose (max 1000mg amoxicillin/dose)*  enterally bid 

OR 

Ampicillin-sulbactam (Unasyn) 50 mg ampicillin/kg/dose (max 2000 mg ampicillin/dose) IV q6h  

Choice of IV vs. enteral depending on illness severity; switch to enteral upon clinical improvement 

Penicillin or cephalosporin allergy with higher risk for allergic reaction: 

Clindamycin
10 mg/kg/dose (max 900 mg/dose) IV q8h  

OR  

Clindamycin
10 mg/kg/dose (max 600 mg/dose) enterally tid 

If patient is ill enough for inpatient care, consider evaluation for Orbital Cellulitis/Abscess, consider Ophthalmology consult 

*See guidance on Amoxicillin-Clavulanate maximum dosing and formulations 

Duration: 5-7 days or until resolution of inflammation. Duration may need to be extended to treat associated sinusitis. See Sinusitis section.