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Periorbital Infections Medication

  • Author: Bobak Zonnoor , MD; Chief Editor: Robert E O'Connor, MD, MPH  more...
 
Updated: Dec 02, 2015
 

Medication Summary

Antibiotics are used in the treatment of periorbital infections, with the specific disorder dictating whether topical, oral, or intravenous agents are administered. As previously stated, for example, treatment of orbital cellulitis commonly starts with intravenous antibiotics in pediatric patients and with oral antibiotics in adults.

Topical antibiotics such as bacitracin, erythromycin, and levofloxacin are used in cases of blepharitis, if the disease is thought to be infectious.

Bacteria frequently associated with periorbital infections include species of Streptococcus and Staphylococcus.

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Antibiotics, Other

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Cephalexin (Keflex)

 

Cephalexin is a first-generation cephalosporin that inhibits bacterial replication by inhibiting bacterial cell wall synthesis. It is bactericidal and effective against rapidly growing organisms forming cell walls. Resistance occurs through alteration of penicillin-binding proteins.

Cephalexin is effective for the treatment of infections caused by streptococci or staphylococci, including penicillinase-producing staphylococci. It may be used to initiate therapy when streptococcal or staphylococcal infection is suspected. The drug is used orally when outpatient management is indicated.

Cephalexin has a half-life of 50-80 minutes. Only 10% is protein bound and more than 90% is recovered unchanged in urine.

Ampicillin and sulbactam (Unasyn)

 

This agent features ampicillin combined with a beta-lactamase inhibitor. It interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. The ampicillin-sulbactam combination provides useful coverage for most organisms associated with dacryocystitis.

Clindamycin (Cleocin)

 

This agent is a semisynthetic antibiotic produced by 7(S)-chloro-substitution of the 7(R)-hydroxyl group of the parent compound, lincomycin. Clindamycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl transfer ribonucleic acid (tRNA) from ribosomes, causing RNA-dependent protein synthesis to arrest. The drug is widely distributed in the body without penetration of the central nervous system (CNS). It is protein bound and excreted by the liver and kidneys.

Clindamycin is used for the treatment of serious skin and soft tissue staphylococcal infections. It is also effective against aerobic and anaerobic streptococci (except enterococci). As an alternative to sulfonamides, clindamycin may be beneficial when used with pyrimethamine in acute treatment of CNS toxoplasmosis in patients with acquired immunodeficiency syndrome (AIDS).

Trimethoprim/sulfamethoxazole (Bactrim DS, Septra DS)

 

Trimethoprim/sulfamethoxazole inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. The antibacterial activity of trimethoprim/sulfamethoxazole includes common urinary tract pathogens, except Pseudomonas aeruginosa.

Doxycycline (Doryx, Doxy 100, Periostat, Oraxyl, Vibramycin)

 

Doxycycline is a broad-spectrum, synthetically derived, bacteriostatic antibiotic in the tetracycline class. It is almost completely absorbed, concentrates in bile, and is excreted in urine and feces as a biologically active metabolite in high concentrations.

Doxycycline inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. It may block the dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Vancomycin

 

Vancomycin is a potent antibiotic directed against gram-positive organisms and active against Enterococcus species. It is useful in the treatment of septicemia and skin structure infections and is indicated for patients who cannot receive, or have failed to respond to, penicillins and cephalosporins or who have infections with resistant staphylococci. For abdominal penetrating injuries, vancomycin is combined with an agent active against enteric flora and/or anaerobes.

To avoid toxicity, the current recommendation is to assay vancomycin trough levels after the third dose, drawn 0.5 hour prior to the next dosing. Use creatinine clearance to adjust the dose in patients diagnosed with renal impairment.

Vancomycin is used in conjunction with gentamicin for prophylaxis in penicillin-allergic patients undergoing gastrointestinal or genitourinary procedures.

Cefuroxime (Ceftin, Zinacef)

 

Cefuroxime is a second-generation cephalosporin that maintains the gram-positive activity found in first-generation cephalosporins and adds activity against Proteus mirabilis, H influenzae, E coli, K pneumoniae, and M catarrhalis.

The condition of the patient, the severity of infection, and the susceptibility of the microorganism determine the proper dose and route of administration.

Nafcillin

 

Nafcillin is used in the initial therapy for suspected penicillin G-resistant streptococcal or staphylococcal infections. Parenteral therapy should be used initially in severe infections, with a change made to oral treatment as the condition warrants.

Because of thrombophlebitis, particularly in elderly persons, nafcillin should be administered parenterally only for a short term (1-2 days); change to an oral antibiotic should be made as clinically indicated.

Amoxicillin and clavulanic acid (Augmentin)

 

This drug combination treats bacteria resistant to beta-lactam antibiotics. For children older than 3 months, base the dosing protocol on amoxicillin content. Because of different amoxicillin/clavulanic acid ratios in the 250 mg tablet (250/125) versus the 250 mg chewable tablet (250/62.5), do not use the 250 mg tablet until the child weighs more than 40 kg.

Cefaclor

 

Cefaclor is a second-generation cephalosporin indicated for infections caused by susceptible gram-positive cocci and gram-negative rods. Determine the proper dosage and route based on the patient's condition, the infection's severity, and the causative organism's susceptibility.

Tetracycline

 

Tetracycline treats gram-positive and gram-negative organisms as well as mycoplasmal, chlamydial, and rickettsial infections. It inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunits.

Bacitracin (Baciguent)

 

This agent prevents the transfer of mucopeptides into the growing cell wall, inhibiting bacterial growth.

Erythromycin ophthalmic (Ilotycin)

 

This agent is a macrolide antibiotic that binds to the 50S ribosomal subunit, blocking dissociation of peptidyl tRNA from the ribosomes and causing RNA-dependent protein synthesis to arrest. It does not affect nucleic acid synthesis.

Erythromycin ophthalmic is indicated for infections caused by susceptible strains of microorganisms and for the prevention of corneal and conjunctival infections.

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Contributor Information and Disclosures
Author

Bobak Zonnoor , MD Resident Physician, Department of Emergency Medicine, SUNY Downstate Medical Center, Kings County Hospital

Bobak Zonnoor , MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Elizabeth Fiedler, MD Clinical Instructor, Department of Emergency Medicine, Montefiore Medical Center-Weiler Division

Elizabeth Fiedler, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Zach Kassutto, MD, FAAP Director, Pediatric Emergency Medicine, Capital Health System; Associate Professor of Pediatrics and Emergency Medicine, Drexel University College of Medicine; Attending Physician, St Christopher's Hospital for Children

Zach Kassutto, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Association for Physician Leadership, American Heart Association, Medical Society of Delaware, Society for Academic Emergency Medicine, Wilderness Medical Society, American Medical Association, National Association of EMS Physicians

Disclosure: Nothing to disclose.

Additional Contributors

R Gentry Wilkerson, MD, FACEP, FAAEM Assistant Professor, Coordinator for Research, Department of Emergency Medicine, University of Maryland School of Medicine

R Gentry Wilkerson, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Acknowledgements

Edmond A Hooker II, MD, DrPH, FAAEM Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine

Edmond A Hooker II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Periorbital cellulitis. This image shows an 8-year-old patient who presented with unilateral eyelid swelling and erythema.
Acute dacryocystitis.
Upper eyelid anatomy.
Lower eyelid anatomy.
Eye and lacrimal duct, anterior view.
 
 
 
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