Facial cellulitis / erysipelas (urgent referral pathway)

1-2 g IV or IM once daily; immediate referral for inpatient parenteral therapy

50-75 mg/kg/day [child max 2000 mg]

(Child: 50-75 mg/kg once daily IV/IM (max 2000 mg daily); urgent pediatric hospital admission mandatory. The formulary's Prescribing Limits box caps a child at 2 g daily for most infections and 4 g daily for endocarditis or meningitis.)

WATCH group - carries resistance cost. Egyptian EML 2025.

Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), p. 246, ceftriaxone monograph, Prescribing Limits: "Pediatric Patients Endocarditis or meningitis: Maximum 4 g daily. Most other infections: Maximum 2 g daily."

Facial cellulitis carries high risk of cavernous sinus thrombosis and intracranial extension; requires urgent IV therapy

875/125 mg orally twice daily (or 1000/200 mg IV 3 times daily) for mild, non-toxic early erysipelas without orbital signs x 5-7 days

25-45 mg/kg/day [child max 1750 mg]

(Child >3 months: 25-45 mg/kg/day divided BID (based on amoxicillin component))

Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph)

Oral outpatient step-down or initial treatment strictly for mild, early non-orbital cases

Usual adult dosage range: Oral: 250 to 1,000 mg every 6 hours or 500 mg every 12 hours (maximum: 4 g/day). x 5 days

25-50 mg/kg/day [child max 2000 mg]

(Mild to moderate infection: Oral: 25 to 50 mg/kg/day divided every 6 or 12 hours; maximum daily dose: 2,000 mg/day.)

Cephalexin is the first choice here; cefazolin is a further option.

Egyptian National Drug Formulary - Antimicrobial 2023

First-generation oral cephalosporin providing first-line spectrum against Group A Streptococcus and MSSA for mild nonpurulent cellulitis or step-down oral therapy.

1 to 2 g IV every 8 hours x 5 days

25-100 mg/kg/day [child max 6000 mg]

(General dosing, susceptible infection: Infants, Children, and Adolescents: IM, IV: Mild to moderate infections: 25 to 100 mg/kg/day divided every 8 hours; maximum daily dose: 6 g/day.)

Egyptian National Drug Formulary - Antimicrobial 2023

Parenteral first-generation cephalosporin for hospitalized patients with severe or systemic non-MRSA facial cellulitis.

300 to 450 mg six-hourly

No paediatric dose for facial cellulitis in the sources opened.

Cellulitis - StatPearls - NCBI Bookshelf (NBK549770)

Ceftriaxone, co-amoxiclav, cephalexin and cefazolin are all beta-lactams, so a patient with a severe penicillin allergy needs something else; clindamycin covers streptococci and staphylococci including MRSA.

800 mg / 160 mg twice a day, given together with cephalexin 500 mg every 6 hours x 5 days

Contraindicated in infants under 2 months. No paediatric cellulitis dose in the sources opened.

Cellulitis - StatPearls - NCBI Bookshelf (NBK549770)

Purulent cellulitis, an associated abscess, a puncture wound or injecting drug use all raise the chance of MRSA, and nothing else listed covers it; the combination is added to the cephalexin rather than replacing it, because on its own it covers streptococci poorly.