| Condition | Major Pathogens | First Choice Therapy | Alternative Therapy | Comments |
|---|---|---|---|---|
|
Periorbital/preseptal cellulitis, suspected to be caused by skin flora (most common) |
Group A streptococcus Staphylococcus aureus
|
Cephalexin OR Cefazolin 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 OR Clindamycin |
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) 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 OR Clindamycin |
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. |
Reference:
American Academy of Pediatrics. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2021.
Pediatric Empiric Antimicrobial Therapy Guidelines
This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites.
These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.
For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK.
The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.