What is the recommended treatment for pediatric patients with periorbital cellulitis?

From the Guidelines

The recommended treatment for pediatric patients with periorbital cellulitis typically involves antibiotics targeting common causative organisms, with IV antibiotics reserved for moderate to severe cases or those with signs of orbital involvement. For mild cases, oral antibiotics such as amoxicillin-clavulanate (40-45 mg/kg/day divided every 12 hours) or cefdinir (14 mg/kg/day divided every 12 hours) for 7-10 days are appropriate 1. Key considerations in management include:

• Monitoring for signs of orbital involvement, including eye movement restriction, proptosis, or vision changes, which would indicate progression to orbital cellulitis requiring more aggressive management 1.
• Using warm compresses to reduce inflammation, and analgesics like acetaminophen or ibuprofen to manage pain and fever.
• Continuing treatment until clinical improvement is evident, typically with 24-48 hours of afebrile status and reduced swelling. This approach targets Staphylococcus aureus, Streptococcus species, and Haemophilus influenzae, which are common pathogens in periorbital infections, while preventing spread to the orbital tissues which could threaten vision 1. In cases where there is suspicion of orbital involvement or severe infection, hospitalization with intravenous antibiotics such as ceftriaxone (50-75 mg/kg/day) or ampicillin-sulbactam (100-200 mg/kg/day divided every 6 hours) may be necessary 1. It's crucial to differentiate preseptal cellulitis from postseptal cellulitis and abscess through clinical findings and imaging when necessary, as the management and potential complications can significantly differ 1.

From the FDA Drug Label

For the treatment of skin and skin structure infections, the recommended total daily dose is 50 to 75 mg/kg given once a day (or in equally divided doses twice a day). The total daily dose should not exceed 2 grams

The recommended treatment for pediatric patients with periorbital cellulitis is IV ceftriaxone at a dose of 50 to 75 mg/kg per day, given once a day (or in equally divided doses twice a day), with a maximum daily dose of 2 grams 2.

From the Research

Treatment Overview

• The recommended treatment for pediatric patients with periorbital cellulitis typically involves the use of intravenous (IV) antibiotics 3, 4, 5, 6.
• The choice of antibiotic should be based on the suspected causative bacteria, with coverage for common pathogens such as Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA) 3, 7.
• Vancomycin is often recommended for MRSA infections 3.

Antibiotic Options

• Amoxicillin-clavulanic acid is a commonly used antibiotic for the treatment of periorbital cellulitis 5.
• Other antibiotics, such as oxacillin, may be used, but their efficacy may be decreasing due to the increasing prevalence of MRSA 3.
• The use of steroids may be considered in some cases, but their effectiveness is not well established 5, 7.

Management Approach

• A multidisciplinary approach is recommended, involving pediatricians, ophthalmologists, and other specialists as needed 4, 5.
• Imaging studies, such as CT scans, may be necessary to differentiate between preseptal and orbital cellulitis and to identify any underlying conditions, such as sinusitis 4, 5, 7.
• Surgical intervention may be required in some cases, particularly if there is evidence of an orbital abscess or other complications 4, 5.