Orbital cellulitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]; Tarek Nafee, M.D. [3]

Overview

Orbital cellulitis is considered an ophthalmologic emergency. The mainstay of therapy for orbital cellulitis involves prompt intravenous antimicrobial therapy with either beta-lactams or clindamycin. Patients suspected to have MRSA-induced orbital cellulitis require more extensive antimicrobial therapy.

Medical Therapy

Antimicrobial Regimens

  • Preferred regimen (1): Ampicillin/Sulbactam 3 g IV q6h for 1 week
  • Preferred regimen (2): Ceftriaxone 1-2 g IV q12h for 1 week
  • Preferred regimen (3): Clindamycin 300 mg IV q6h for 1 week
  • Preferred regimen (4): Nafcillin 2 g IV q4h for 1 week AND Ceftriaxone 2 g IV q24h for 1 week AND Metronidazole 30-35 mg/kg/d IV divided in 3 doses for 1 week
  • Alternative regimen (1), MRSA suspicion: Vancomycin 1 g IV q12h for 1 week AND Ceftriaxone 2 g IV q24h for 1 week AND Metronidazole 30-35 mg/kg/d IV divided q8h for 1 week
  • Alternative regimen (2), MRSA suspicion: Vancomycin 1 g IV q12h for 1 week AND Levofloxacin 750 mg IV q24h for 1 week AND Metronidazole 30-35 mg/kg/d IV divided q8h for 1 week
  • Alternative regimen (3), pediatric: Ampicillin/Sulbactam 200-300 mg/kg/d IV divided q6h for 1 week
  • Alternative regimen (4), pediatric: Ceftriaxone 100 mg/kg/d IV divided q12h for 1 week
  • Alternative regimen (5), pediatric: Clindamycin 20-40 mg/kg/d IV divided q12 for 1 week
  • Note (1): Oral antibiotic therapy may be extended beyond 2-3 weeks if the clinical presentation is consistent with either severe sinusitis or bony destruction
  • Note (2): Consider surgical intervention if the patient has either visual loss, complete ophthalmoplegia, large abscess > 1 cm, or no clinical improvement following 1-2 days of antibiotic administration
  • 3. Pathogen-directed antimicrobial therapy
  • 3.2 Non-MRSA organisms

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