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.
Therapeutic regimens for H influenzae periorbital cellulitis are listed below.
Amoxicillin-clavulanate (see age-based dosing regimens below)
Cefpodoxime (see age-based dosing regimens below)
Cefdinir (see age-based dosing regimens below)
Ceftriaxone (see age-based dosing regimens below)
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)
Cefuroxime (see age-based dosing regimens below)
Ceftriaxone (see age-based dosing regimens below)
Clindamycin (see age-based dosing regimens below)
Therapeutic regimens for MRSA periorbital cellulitis are listed below.
Vancomycin (see age-based dosing regimens below)
Daptomycin 4-6 mg/kg IV q24h[3] or
Clindamycin (see age-based dosing regimens below)
Trimethoprim-sulfamethoxazole (see age-based dosing regimens below)
Doxycycline (see age-based dosing regimens below)
Therapeutic regimens for streptococcal periorbital cellulitis are listed below.
Vancomycin (see age-based dosing regimens below)
Trimethoprim-sulfamethoxazole (see age-based dosing regimens below)
Amoxicillin (see age-based dosing regimens below)
Amoxicillin-clavulanic acid (see age-based dosing regimens below)
Ceftriaxone (see age-based dosing regimens below)
Erythromycin (see age-based dosing regimens below)
Therapeutic regimens for anaerobic periorbital cellulitis are listed below.
Piperacillin/tazobactam (see age-based dosing regimens below)
Amoxicillin-clavulanic acid (see age-based dosing regimens below)
Metronidazole (see age-based dosing regimens below)
Clindamycin (see age-based dosing regimens below)
Imipenem/cilastatin (see age-based dosing regimens below)
Chloramphenicol (see age-based dosing regimens below)
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]