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Dr. Grogg often reaches for Dicloxacillin when treating preseptal cellulitis. It is also an excellent choice for other lid-related issues like dacryocystitis when in the initial acute phase and canaliculitis. Dicloxacillin is a penicillinase-resistant penicillin which is required in treating lid disorders. Most "bugs" around the eye produce penicillinase which renders ineffective any drugs which are not penicillinase resistent.
Typical dose (depending upon severity) is 250 mg QID x 7-10 days. Dicloxacillin is also available as 500 mg given twice daily which could aid in patient compliance.
Dicloxacillin is an extremely well tolerated antibiotic. Side effects are minimal with few complaints about stomach upset. Obviously, it cannot be given to patients who are penicillin allergic.
This antibiotic is inexpensive. A 10-day course will cost less than $10.
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Preseptal Cellulitis
Symptoms include pain, tenderness, and redness in the periorbital area.
Signs. Look for erythema in the periorbital area. Preseptal cellulitis is usually associated with a hordeolum, although very often they are not even visible, but the pain can be localized. Check for preauricular nodes. There may not always be a preauricular node, but if the infection is severe enough, there will be. (A preauricular node is helpful when trying to determine whether the condition is due to an allergic or infectious response.)
Keep in mind the differential diagnosis of orbital cellulitis. Patients with orbital cellulitis may have a fever, decreased ocular motility, and diplopia symptoms.
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This is a typical presentation of a preseptal cellullitis patient. In this case, the right eyelid is clearly swollen and is tender. Palpating along the lid, the tender area is usually easily localized by the patient. In this case, it appears the nasal aspect of the eyelid is slightly more swollen, so it would be expected that the patient would have more tenderness in that area. |
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In preseptal cellulitis patients, there should be only minimal pain with eye movement and no diplopia. Check temperature.
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How to write a prescription for oral medications
Take the time to ensure that the prescriptions you write are legible and contain all necessary information. A simple format in prescription writing consists of 3 lines on the Rx form:
- The first line is the name of the drug and the milligram dosage you are prescribing.
- The second line is the "Dispense" line, abbreviated as "Disp." This line is to specify the amount of the medication you wish to prescribe. For example, 2 tablets for 7 days, would be a "disp" of 14 tabs.
- The third line is the "Sig" (instructions) line. This is written to the pharmacist to describe how the patient is to take the medication.
In an attempt to decrease errors in reading prescriptions, the current trend in prescription writing is moving away from Latin in favor of writing out prescriptions in long hand. Some practices have a check-off list on their Rx pads; it helps eliminate errors from bad handwriting. |

Basic components of a prescription. |

Sample prescription for Dicloxacillin. |
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