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http://www.revoptom.com/content/c/20600/
VOLUME 5, NUMBER 3
June 26, 2015

A 16-YEAR-OLD PATIENT WITH A HISTORY OF MULTIPLE HORDEOLA PRESENTS WITH WHAT APPEARS TO BE A PRESEPTAL CELLULITIS. WHICH MEDICATIONS ARE MOST APPROPRIATE FOR THIS INDIVIDUAL?

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In all cases of suspected preseptal cellulitis, you must first rule out an orbital cellulitis. To do this, ensure that the patient demonstrates complete extraocular muscle motility, as well as exhibits no evidence of diplopia, relative afferent pupillary defect or pain upon eye movement.

Once you've ruled out orbital cellulitis, you must start the patient on a course of oral antibiotics. The best options include:
  • Augmentin (amoxicillin/clavulanic acid, GlaxoSmithKline) 875mg BID or 500mg TID is an excellent option—provided that the patient is not allergic to penicillin. Also, keep in mind that elderly patients, or those with dysphagia, may report difficulty swallowing 875mg pills.
  • Keflex (cephalexin, Eli Lily) at 500mg BID is effective for soft tissue infections. Take note, however, that this agent is a cephalosporin, and thus presents a very small risk for cross-reaction in patients who are allergic to penicillin.
  • Bactrim (trimethoprim/sulfamethoxazole, Roche) 400mg/80mg BID is an ideal option for patients who are diagnosed with, or are suspected of, an active MRSA infection. Bactrim is contraindicated in patients with documented sulpha allergies.
  • Doxycycline, dosed at 100mg BID, may be helpful because of its powerful anti-inflammatory properties. However, the medication is contraindicated in pregnant or nursing women.
  • Azithromycin, prescribed as a five-day Z-pak (Pfizer), may be a viable option if most of the aforementioned medications are contraindicated.
Keep in mind that all of these medications (save for the five-day Z-pak), should be used for seven consecutive days, even if the condition resolves sooner.

Thanks to Nathan Lighthizer, OD, of Tahlequah, OK, for his contributions to this week's pearl.
http://www.revoptom.com/content/c/20600/

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