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Applying Pharmacodynamics and Antimicrobial Stewardship to Pediatric Preseptal and Orbital Cellulitis

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Abstract

Orbital and preseptal cellulitis are most commonly caused by organisms that originate in the upper respiratory tract or from the skin. There is significant variation in antibiotics used, but ampicillin–sulbactam, ceftriaxone, metronidazole, clindamycin, amoxicillin, amoxicillin–clavulanate, cefuroxime, and vancomycin are often used in the treatment of these infections. The choice of antibiotic, however, is only one consideration. It is also important that antibiotics are dosed to optimize their pharmacodynamic target attainment. Like other serious infections, therapy can be transitioned from initial intravenous therapy to an oral regimen when there are clear signs of clinical and laboratory improvement. The total duration of therapy for these infections have also been decreasing in recent years with durations of approximately 2 weeks becoming more common, even for orbital or subperiosteal infections. Antimicrobial stewardship programs can work closely with providers who manage these infections to create pathways, choose optimal antibiotics and dosage, transition from intravenous to oral therapy, and provide shortest effective durations.

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Authors and Affiliations

  1. Departments of Pharmacy Practice and Pediatrics, University of Connecticut, Storrs, CT, 06269, USA

    Grant T. Stimes & Jennifer E. Girotto

  2. Connecticut Children’s, Hartford, CT, 06106, USA

    Grant T. Stimes & Jennifer E. Girotto

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  1. Grant T. Stimes
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  2. Jennifer E. Girotto
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Correspondence to Jennifer E. Girotto.

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Dr. Stimes has no conflicts of interest to disclose; Dr. Girotto is on the Editorial Board of Pediatric Drugs. The authors received no financial support for the publication of this article.

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Stimes, G.T., Girotto, J.E. Applying Pharmacodynamics and Antimicrobial Stewardship to Pediatric Preseptal and Orbital Cellulitis. Pediatr Drugs 21, 427–438 (2019). https://doi.org/10.1007/s40272-019-00357-3

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