Bactrim Dosing for Hordeolum Cellulitis
Rationale for Dosing
- The Infectious Diseases Society of America recommends Bactrim (sulfamethoxazole/trimethoprim) for hordeolum cellulitis, which is often caused by Staphylococcus aureus, including community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), with a dosage of 1 double-strength tablet (160 mg trimethoprim/800 mg sulfamethoxazole) orally twice daily for 7-10 days 1
- Bactrim is effective against purulent cellulitis, including hordeolum cellulitis, with the standard adult dose for skin and soft tissue infections being 1 double-strength tablet (160 mg trimethoprim/800 mg sulfamethoxazole) twice daily 1
Special Populations
- Bactrim is contraindicated in pregnant women in the third trimester 1
Efficacy and Monitoring
- Clinical improvement with Bactrim should be evident within 48-72 hours of initiating therapy, and if no improvement is seen, consider possible resistance to Bactrim or need for incision and drainage if abscess formation has occurred 1
- If Bactrim is not effective, alternative antibiotic therapy may be necessary, with options including Clindamycin, Doxycycline, or Linezolid 1
Potential Adverse Effects
- Common adverse effects of Bactrim include rash, urticaria, nausea, vomiting, and gastrointestinal disturbances, while rare but serious adverse effects include Stevens-Johnson syndrome 1
- Alternative antibiotics like Clindamycin, Doxycycline, or Linezolid may have different adverse effect profiles, with Clindamycin 300-450 mg orally three times daily, Doxycycline 100 mg orally twice daily, or Linezolid 600 mg orally twice daily being potential options 1, 2
Alternative Options
- The American Academy of Pediatrics and the Infectious Diseases Society of America recommend considering alternative antibiotics such as Clindamycin 300-450 mg orally three times daily, Doxycycline 100 mg orally twice daily, or Linezolid 600 mg orally twice daily if Bactrim is contraindicated or not tolerated 1
Clinical Pearls
- Incision and drainage should be performed if fluctuance is present, but antimicrobial therapy with Bactrim is still recommended for surrounding cellulitis, and patient should be advised to complete the full course of antibiotics even if symptoms improve rapidly 1