Patients at low risk of MRSA infection
For patients with periorbital cellulitis who do not have concurrent sinusitis nor risk factors for Haemophilus influenzae type b (Hib) infection, and who are at low risk of methicillin-resistant Staphylococcus aureus (MRSA) infection (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), use:
1dicloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see dicloxacillin dosage adjustment. See advice on patient review, and modification and duration of therapy dicloxacillin dicloxacillin dicloxacillin
OR
1flucloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see flucloxacillin oral dosage adjustment. See advice on patient review, and modification and duration of therapy. flucloxacillin flucloxacillin flucloxacillin
Cefalexin is often preferred to dicloxacillin or flucloxacillin in children because the liquid formulation is better tolerated. It can also be used in patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin1. Use:
1cefalexin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see cefalexin dosage adjustment. See advice on patient review, and modification and duration of therapy cefalexin cefalexin cefalexin
OR if adherence to a 6-hourly regimen is unlikely in a child
1cefalexin 20 mg/kg up to 750 mg orally, 8-hourly2. See advice on patient review, and modification and duration of therapy.
For patients who have had a severe (immediate or delayed)3 hypersensitivity reaction to a penicillin, use trimethoprim+sulfamethoxazole or clindamycin (see Patients at increased risk of MRSA infection for dosages).