What is the treatment for orbital cellulitis?

From the Guidelines

Orbital cellulitis is a serious infection that requires prompt treatment with intravenous antibiotics. The choice of antibiotic depends on the suspected causative organism, and a common regimen is a combination of vancomycin 15-20 mg/kg every 8-12 hours and ceftriaxone 50-75 mg/kg every 12-24 hours, or alternatively, cefepime 50 mg/kg every 8-12 hours 1.

Key Considerations

• The duration of treatment is typically 7-14 days, but may be longer depending on the severity of the infection and the patient's response to treatment 1.
• In addition to antibiotics, supportive care such as pain management, hydration, and monitoring for complications is also important.
• In severe cases, surgical intervention may be necessary to drain abscesses or relieve pressure on the orbit.
• It is essential to consult an ophthalmologist or an infectious disease specialist for guidance on treatment 1.

Antibiotic Selection

• Vancomycin is recommended to cover possible methicillin-resistant S pneumoniae 1.
• The choice of antibiotic should be tailored to the results of culture and sensitivity studies when they become available 1.

Severity Assessment

• Mild cases of preseptal cellulitis may be treated on an outpatient basis with appropriate oral antibiotic therapy 1.
• Severe cases require hospitalization and intravenous antibiotics, and may require surgical intervention 1.

From the Research

Treatment Overview

The treatment for orbital cellulitis typically involves:

• Early administration of broad-spectrum antibiotics 2, 3, 4, 5, 6
• Ophthalmology consultation 2
• Possible use of steroids, although this is controversial 2
• Surgical drainage in certain cases, such as abscess formation or intracranial extension of infection 2, 4

Antibiotic Treatment

• The choice of antibiotics should be based on the suspected or confirmed pathogen and its antibiotic susceptibility 5
• Common pathogens include Staphylococcus aureus 5
• Antibiotics such as amikacin and vancomycin may be effective in cases with drug resistance 5

Surgical Intervention

• Surgical drainage may be necessary in cases of abscess formation or intracranial extension of infection 2, 4
• Procedures such as functional endoscopic sinus surgery (FESS) may be performed in conjunction with surgical drainage 4

Monitoring and Follow-up

• Close monitoring is essential to detect any signs of progression or complications 4
• Prompt intervention is necessary in cases of refractory orbital cellulitis or abscess formation 4