Preseptal cellulitis, also known as periorbital cellulitis, is an infection of the tissues surrounding the eye and is commonly found in children under six years of age. The infection may occur due to an injury in the area around the eye, or it may spread from another site of infection. Staphylococcus aureus, Streptococcus pyogenes and Haemophilus influenzae are the most common bacteria associated with preseptal cellulitis. Early diagnosis and prompt treatment with appropriate antibiotics are crucial to prevent complications.
Ampicillin
The Merck Manual for Health Care Professionals recommends intravenous administration of ampicillin for seven days to treat preseptal cellulitis in hospitalized patients. Ampicillin belongs to the penicillin family and acts by disrupting the bacterial cell wall, thereby causing cell death. However, strains of Staphylococcus aureus and Heamophilus influenzae that produce an enzyme called beta-lactamase are resistant to ampicillin. In such cases, ampicillin-sublacatm, which is a combination of ampicillin and a beta-lactamase inhibitor called sublactam, can be used intravenously every six hours for seven days.
Patients who have history of penicillin allergies are allergic to ampicillin, as well. Other common side effects include upset stomach, reduced urination, headache and oral thrush.
Cephalosporins
According to the information published by the University of California San Diego, very young children, unimmunized individuals and those with possible blood infections should be hospitalized and should be given cephalosporins such as cefuroxime, cefotaxime and ceftriaxone for at least 48 hours or until the patient's fever is under control for 24 hours. The patient may then be given antibiotics orally for about 14 days.
The mechanism of action of cephalosporins is similar to penicillin. However, not all individuals with penicillin allergies are allergic to cephalosporins. Common side effects of cephalosporins are skin rash and gastric disturbances.
Amoxicillin-clavulanate
Amoxicillin-clavulanate is the most common antibiotic prescribed to treat patients with mild preseptal cellulitis who do not require hospitalization. This drug is usually taken orally for about 10 days. However, the Merck Manual for Health Care Professionals states that this oral antibiotic should be prescribed only if a more serious infection of the eyeball itself has been ruled out and the patient should be closely monitored by an ophthalmologist.
Amoxicillin-clavulanate, also, consists of amoxicillin, a penicillin derivative, along with clavulanate, which has the ability to inhibit beta-lactamase enzyme. Individuals allergic to penicillin would be allergic to this drug. Nausea, vomiting, diarrhea and skin rash are some of the other common side effects.
Clindamycin
Clindamycin is used to treat mild cases of preseptal cellulitis that are caused by drug-resistant strains of Staphylococcus aureus such as methicillin resistant Staphylococcus aureus, or MRSA. This antibiotic is usually taken orally and is used for outpatient treatment. Clindamycin is also an effective choice in individuals with penicillin allergies.
Clindamycin is available in capsule and suspension form, and common side effects include upset stomach, heart burn and vaginal itching. Pubmed Health also warns that clindamycin use could lead to the growth of dangerous bacteria in the intestines, and may lead to a life threatening condition called colitis. Hence, it is important to talk to a doctor about the risks of using clindamycin.
