Pediatric Guidelines: Head and Neck Infections - Periorbital/Preseptal Cellulitis

Condition Major Pathogens First Choice Therapy Alternative Therapy Comments
Periorbital/preseptal cellulitis

Group A streptococcus

Staphylococcus aureus

Streptococcus pneumoniae

Haemophilus influenzae



Clindamycin 10mg/kg/dose PO TID (max 600mg/dose)

If suspected sinus origin and low suspicion for MRSA, Oral/Outpatient:

Amoxicillin-clavulanate (Augmentin) 45mg/kg/dose amoxicillin PO BID (max 1000mg amoxicillin/dose)*

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

*Click here for guidance on Amoxicillin-Clavulanate maximum dosing and formulations

IV/Inpatient (if unable to take PO):

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

If suspected sinus origin and low suspicion for MRSA, IV/Inpatient:

Ampicillin-sulbactam (Unasyn) 50mg/kg/dose ampicillin IV q6h (max 2g ampicillin/dose)

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. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).