Periorbital Cellulitis (Preseptal Cellulitis) Organism-Specific Therapy 

Updated: Sep 21, 2016
  • Author: T Amerson Pegram, MD; Chief Editor: Thomas E Herchline, MD  more...
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Specific Organisms and Therapeutic Regimens

Organism-specific therapeutic regimens for the most common organisms responsible for periorbital cellulitis (also known as preseptal cellulitis), including those for Haemophilus influenzae, methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S aureus (MRSA), streptococcal species, and anaerobes, are provided below. [1]

For empiric therapy, see Periorbital Cellulitis Empiric Therapy.

Haemophilus influenzae periorbital cellulitis

Therapeutic regimens for H influenzae periorbital cellulitis are listed below.

Amoxicillin-clavulanate (see age-based dosing regimens below)

  • Pediatric: 45-90 mg/kg/day divided q12h for 10-14 days
  • Adult: 875 mg PO q12h for 10-14 days  or

Cefpodoxime (see age-based dosing regimens below)

  • Pediatric: 10 mg/kg/day divided q12h for 10 days
  • Adult: 200-400 mg PO q12h for 10-14 days  or

Cefdinir (see age-based dosing regimens below)

  • Pediatric: 14 mg/kg/day PO divided q12h for 10 days (maximum 600 mg/day)
  • Adult: 600 mg PO daily for 10-14 days  or

Ceftriaxone (see age-based dosing regimens below)

  • Pediatric: 50-100 mg/kg/day IM/IV
  • Adult: 1-2 g IM/IV q24h [2]

Staphylococcus aureus, methicillin susceptible (MSSA) periorbital cellulitis

Therapeutic regimens for MSSA periorbital cellulitis are listed below.

Ampicillin-sulbactam 1.5-3 g IV q6h for 10-14 days or

Amoxicillin-clavulanic acid (see age-based dosing regimens below)

  • Pediatric: 45-90 mg/kg/day divided q12h for 10-14 days
  • Adult: 875 mg PO q12h for 10-14 days  or

Cefuroxime (see age-based dosing regimens below)

  • Children aged 3 months or older: 50-100 mg/kg/day IM/IV divided q8h for 10-14 days (maximum 9 g/day)
  • Adult: 1.5 g IV q8h for 10-14 days  or

Ceftriaxone (see age-based dosing regimens below)

  • Pediatric: 50-100 mg/kg/day IM/IV divided q12h (maximum 4 g/day)
  • Adult: 1 g IV daily for 10-14 days  or

Clindamycin (see age-based dosing regimens below)

  • Pediatric: 30-40 mg/kg/day divided q8h for 10-14 days (maximum 1.8 g/day)
  • Adult: 600 mg IV/PO q8h for 10-14 days

Staphylococcus aureus, methicillin resistant (MRSA) periorbital cellulitis

Therapeutic regimens for MRSA periorbital cellulitis are listed below.

Vancomycin (see age-based dosing regimens below)

  • Age 1 month to 11 years: 10-15 mg/kg IV q6-8h (maximum 1 g per dose)
  • Older than 12 years: 1 g (15 mg/kg) q12h for 7-10 days  or

Daptomycin 4-6 mg/kg IV q24h [3]  or 

Clindamycin (see age-based dosing regimens below)

  • Pediatric: 30-40 mg/kg/day divided q8h for 10-14 days (maximum 1.8 g/day)
  • Adult: 600 mg IV/PO q8h for 10-14 days [4] or

Trimethoprim-sulfamethoxazole (see age-based dosing regimens below)

  • Pediatric: Trimethoprim 8-10 mg/kg/day PO/IV divided q12h for 10 days
  • Adult: Trimethoprim 160 mg PO q12h for 10 days  or

Doxycycline (see age-based dosing regimens below)

  • Children older than 8 years: 2-4 mg/kg/day PO divided q12h for 7-10 days
  • Adult: 100 mg PO/IV q12h for 1 day, then 100 mg PO/IV q24h for 10-14 days

Streptococcal periorbital cellulitis

Therapeutic regimens for streptococcal periorbital cellulitis are listed below.

Vancomycin (see age-based dosing regimens below)

  • Age 1 month to 11 years: 10-15 mg/kg IV q6-8h (maximum 1 g/dose)
  • Older than 12 years: 1 g (15 mg/kg) q12h for 7-10 days  or

Trimethoprim-sulfamethoxazole (see age-based dosing regimens below)

  • Pediatric: Trimethoprim 8-10 mg/kg/day PO/IV divided q12h for 10 days
  • Adult: Trimethoprim 160 mg PO q12h for 10 days  or

Amoxicillin (see age-based dosing regimens below)

  • Pediatric: 80-100 mg/kg/day divided q12h for 10 days (maximum 500 mg/dose)
  • Adult: 875 mg PO q24h for 10-14 days  or

Amoxicillin-clavulanic acid (see age-based dosing regimens below)

  • Pediatric: 45 mg/kg/day divided q12h for 10-14 days
  • Adult: 875 mg PO q12h for 10-14 days  or

Ceftriaxone (see age-based dosing regimens below)

  • Pediatric: 50-100 mg/kg/day IM/IV divided q12h (maximum 4 g/day)
  • Adult: 1 g IV daily for 10-14 days  or

Erythromycin (see age-based dosing regimens below)

  • Pediatric: 30-50 mg/kg/day divided q6-8h for 7-10 days (maximum 4 g/day)
  • Adult: 500 mg/day PO q6h for 10-14 days [5]

Anaerobic periorbital cellulitis

Therapeutic regimens for anaerobic periorbital cellulitis are listed below.

Piperacillin/tazobactam (see age-based dosing regimens below)

  • Age 2-9 months: 240 mg/kg/day IV divided q8h for 7-10 days
  • Older than 9 months: 3.375 g IV q6h for 7-10 days  or

Amoxicillin-clavulanic acid (see age-based dosing regimens below)

  • Pediatric: 45 mg/kg/day divided q12h for 10-14 days
  • Adult: 875 mg PO q12h for 10-14 days  or

Metronidazole (see age-based dosing regimens below)

  • Pediatric: 30 mg/kg/day PO/IV divided q6h for 10-14 days (maximum 4 g/day)
  • Adult: 500 mg PO q6-8h for 10-14 days (maximum 1 g/dose) [6] or

Clindamycin (see age-based dosing regimens below)

  • Pediatric: 30-40 mg/kg/day divided q8h for 10-14 days (maximum 1.8 g/day)
  • Adult: 300 mg q8h for 10-14 days [7] or

Imipenem/cilastatin (see age-based dosing regimens below)

  • Pediatric: 60-100 mg/kg/day IV divided q6h (maximum 2-4 g/day)
  • Adult: 1 g IV q8h (maximum 50 mg/kg/day up to 3 g/day)  or

Chloramphenicol (see age-based dosing regimens below)

  • Pediatric: 50-75 mg/kg/day IV divided q6h (maximum 4 g/day)
  • Adult: 50-100 mg/kg/day IV divided q6h (maximum 100 mg/kg/day)

Special considerations

Periorbital cellulitis is a common infection of the eyelid and periorbital soft tissues characterized by acute eyelid erythema and edema.

This bacterial infection usually results from the local spread of an adjacent upper respiratory tract infection, adjacent sinusitis, or an external ocular infection or following trauma to the eyelids. [6]

The most common organisms associated with periorbital cellulitis include Streptococcus pneumoniae, Staphylococcus aureus, other streptococcal species, and anaerobes. [8, 9]

Clinical improvement should occur within 24-48 hours.. If the patient worsens, consider an underlying orbital process or resistant organism(s). In some cases, the treatment duration depends on disease severity.

The condition should be treated initially as orbital cellulitis in children younger than one year, patients who are difficult to examine, and immunocompromised patients.

Surgical drainage is indicated only for abscesses and is usually unnecessary for uncomplicated periorbital cellulitis. [1, 10, 11, 12]