Treatment of Preseptal Cellulitis

Antibiotic Selection

The American College of Physicians and the Infectious Diseases Society of America recommend a 5-day course of antibiotics active against streptococci as first-line therapy for preseptal cellulitis, with extension if the infection has not improved within this time period 1, 2
For typical cases without systemic signs of infection, antimicrobial agents active against streptococci, such as penicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin, cephalexin, and clindamycin, are recommended 1, 3, 4
For cases with systemic signs of infection, consider coverage for both streptococci and methicillin-susceptible S. aureus (MSSA) with options including cefazolin and nafcillin 3, 5, 6

The recommended duration of antibiotic therapy is 5 days, with treatment extended if infection has not improved within this time period 1, 2

Elevation of the affected area to promote drainage of edema and identification and treatment of predisposing factors, such as sinusitis, are recommended 1, 9
Systemic corticosteroids, such as prednisone, could be considered in non-diabetic adult patients to reduce inflammation 1, 8

Hospitalization is recommended for patients with severe infections, including those with SIRS, altered mental status, or hemodynamic instability, and for those with concern for deeper or necrotizing infection 1, 4, 7, 9

For patients with frequent episodes of preseptal cellulitis, consider prophylactic antibiotics, such as oral penicillin or erythromycin, or intramuscular benzathine penicillin 1, 3, 6