Orbital/Post-septal Cellulitis
S. pneumoniae, H. influenzae, M. catarrhalis, oral anaerobes, MSSA/MRSA, S. pyogenes
Ampicillin-sulbactam 200mg ampicillin/kg/day IV div q6h (max dose: 2000 mg ampicillin/dose)
Alternative Regimen:
Ceftriaxone 75mg/kg/dose IV q24h (max 2000mg/dose)
AND
Clindamycin 40 mg/kg/day PO/IV div q8h (max 600mg/dose)
Consider:
Addition of Vancomycin to Ampicillin-sulbactam if there is concern for SIRS/sepsis, large abscess or subperiosteal abscess present on imaging.
Please Note:
When initiating anti-MRSA therapy for periorbital cellulitis (e.g. Clindamycin, Vancomycin), please send MRSA Culture Screen to assist with future narrowing of regimen when applicable.
Empiric Therapy & Alternative Regimens
Duration of Therapy & Clinical Pearls
Consult Infectious Diseases, ENT, and Ophthalmology.
Consider orbital cellulitis in those cases with erythema and edema of the eyelid WITH ocular pain, proptosis, and/or pain with extraocular movements.
Consider obtaining CT w/contrast to assess for complications (orbital abscess, subperiosteal abscess, intracranial extension) & to assess need of surgical drainage.¹
If intracranial extension of infection is clinically suspected or seen on imaging, please refer to “Brain Abscess” below (page 39) to provide a regimen that will appropriately provide CNS penetration.
IV to PO transition:
Consider once afebrile and erythema and pain at site have resolved.³
Length of Therapy:
10-14 day total course at minimum for milder cases. Longer course may be required depending on severity of infection and requirement and timing of surgical drainage of abscesses.³