From the Guidelines
The drug of choice for periorbital cellulitis is high-dose amoxicillin-clavulanate for comprehensive coverage. This recommendation is based on the clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years 1.
Key Considerations
- Periorbital cellulitis is a complication of acute bacterial sinusitis, commonly caused by infection of the ethmoid sinus in otherwise healthy young children.
- The disorder is classified in relation to the orbital septum, with periorbital or preseptal inflammation involving only the eyelid, whereas postseptal (intraorbital) inflammation involves structures of the orbit.
- Mild cases of preseptal cellulitis may be treated on an outpatient basis with oral antibiotic therapy, but hospitalization is required for severe symptoms, immunocompromised patients, or when outpatient treatment fails.
Antibiotic Therapy
- High-dose amoxicillin-clavulanate is recommended for comprehensive coverage of common pathogens, including Staphylococcus aureus, Streptococcus species, and Haemophilus influenzae.
- For patients with risk factors for methicillin-resistant Staphylococcus pneumoniae (MRSP), vancomycin may be added to the treatment regimen 1.
- The duration of therapy typically requires 7-10 days, often beginning with intravenous antibiotics and transitioning to oral antibiotics once clinical improvement occurs.
Monitoring and Follow-up
- Close monitoring for progression to orbital cellulitis is essential, as this represents a medical emergency requiring immediate intervention.
- Daily follow-up is recommended until definite improvement is noted, and consultation with an otolaryngologist, an ophthalmologist, and an infectious disease expert may be necessary for guidance regarding the need for surgical intervention and the selection of antimicrobial agents 1.
From the Research
Drug of Choice for Periorbital Cellulitis
The choice of antibiotic for periorbital cellulitis depends on various factors, including the causative pathogen, patient age, and severity of the infection.
- According to a study published in 1996 2, sulbactam-ampicillin (SAM) with or without ornidazole can be considered as the first line of drug treatment for periorbital cellulitis due to its broad antimicrobial spectrum and low risk of recurrence.
- Another study published in 2010 3 found that intravenous ceftriaxone + clindamycin was an effective treatment for periorbital cellulitis, with a mean duration of 8.6 days.
- A more recent study from 2022 4 suggested that vancomycin is ideal for methicillin-resistant Staphylococcus aureus (MRSA) infections, which have increased in recent decades.
- An older study from 1984 5 recommended parenteral antibiotics, such as those effective against Hemophilus influenzae type B, Streptococcus pneumoniae, Staphylococcus aureus, and group A streptococci, for the treatment of facial and periorbital cellulitis in children.
Key Considerations
- The most common causative pathogens for periorbital cellulitis include Staphylococcus aureus, Streptococcus pneumoniae, and Staphylococcus epidermidis 3.
- Sinusitis and upper respiratory infection are common predisposing factors for periorbital cellulitis 3.
- The use of corticosteroids as an adjunctive treatment for periorbital and orbital cellulitis is still uncertain, with insufficient evidence to draw conclusions 6.