Organism-specific therapeutic regimens for the most common organisms responsible for periorbital cellulitis (also known as preseptal cellulitis) are provided below.[1] Local antibiograms should be consulted in addition to the following guidelines below for methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S aureus (MRSA), streptococcal species, Haemophilus influenzae, and anaerobes.
For empiric therapy, see Periorbital Cellulitis (Preseptal Cellulitis) Empiric Therapy.
Ampicillin-sulbactam
Pediatric
Amoxicillin-clavulanic acid
Pediatric
Adult
Cefuroxime
Children aged 3 months or older
Adult
Ceftriaxone
Pediatric
Adult
Clindamycin
Pediatric
Adult
Vancomycin
Age 1 month to 11 years
Older than 12 years
Daptomycin
Clindamycin
Pediatric
Adult
Trimethoprim-sulfamethoxazole
Pediatric
Adult
Doxycycline
Children older than 8 years
Adult
Vancomycin
Age 1 month to 11 years
Older than 12 years
Trimethoprim-sulfamethoxazole
Pediatric
Adult
Amoxicillin
Pediatric
Adult
Amoxicillin-clavulanic acid
Pediatric
Adult
Ceftriaxone
Pediatric
Adult
Erythromycin
Pediatric
Adult
Amoxicillin-clavulanate
Pediatric
Adult
Cefpodoxime
Pediatric
Adult
Cefdinir
Pediatric
Adult
Ceftriaxone
Pediatric
Adult
Piperacillin/tazobactam
Age 2-9 months
Older than 9 months
Amoxicillin-clavulanate
Pediatric
Adult
Metronidazole
Pediatric
Adult
Clindamycin
Pediatric
Adult
Imipenem/cilastatin
Pediatric
Adult
Chloramphenicol
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)
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.[7]
The most common organisms associated with periorbital cellulitis include Streptococcus pneumoniae, Staphylococcus aureus, other streptococcal species, and anaerobes.[9, 10]
Clinical improvement should occur within 24-48 hours with antibiotic therapy. If the patient worsens, consider an underlying orbital or sinus process, drug allergy, resistant organism(s), and need for hospitalization. In some cases, the treatment duration depends on disease severity.
The condition initially should be treated as orbital cellulitis in children younger than 1 year, patients who are difficult to examine, and patients who are immunocompromised.
Surgical drainage is indicated only for abscesses and is usually unnecessary for uncomplicated periorbital cellulitis. Drainage specimens should be sent for cultures.[1, 11, 12, 13]
There are no recommendations that steroids should be considered routinely in periorbital cellulitis.[14]