From the Guidelines
For a 5-year-old with inferior orbital cellulitis resistant to Augmentin, the recommended treatment is to switch to intravenous antibiotics with broader coverage, typically a combination of vancomycin (15 mg/kg IV every 6 hours) plus either ceftriaxone (50 mg/kg IV once daily) or cefotaxime (50 mg/kg IV every 8 hours), as suggested by the most recent guidelines 1. This approach is based on the understanding that orbital cellulitis resistant to Augmentin likely involves resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) or anaerobes, requiring broader antimicrobial coverage. Key considerations in managing this condition include:
- Hospitalization for IV administration and close monitoring
- Urgent consultation with ophthalmology and possibly ENT to evaluate for complications and potential surgical intervention if an abscess is present
- CT imaging of the orbits and sinuses to assess the extent of infection and rule out subperiosteal or orbital abscess, as recommended by recent studies 1 The rationale for this comprehensive approach is supported by evidence indicating that orbital cellulitis in children often originates from adjacent sinusitis, particularly ethmoid sinusitis, necessitating treatment that addresses both conditions effectively 1. Given the potential for severe complications, including vision loss and intracranial involvement, prompt and aggressive management is crucial, as highlighted in guidelines for the management of skin and soft tissue infections 1.
From the Research
Treatment for Inferior Orbital Cellulitis Resistant to Augmentin
- The treatment for a 5-year-old with inferior orbital cellulitis resistant to Augmentin (amoxicillin-clavulanate) may involve the use of alternative antibiotics, as the infection may be caused by bacteria resistant to Augmentin 2, 3.
- According to a study published in the Journal of Ocular Pharmacology and Therapeutics, Staphylococcus aureus is a common pathogen in orbital cellulitis, and the bacterial susceptibility test showed 100% resistance to penicillin G and ampicillin 3.
- Another study published in Pediatrics found that the Streptococcus anginosus group is an emerging pathogen in pediatric orbital infections, and combination antimicrobial agents, including vancomycin, were frequently used 2.
- A study published in the European Journal of Ophthalmology found that intravenous ceftriaxone + clindamycin was an effective treatment for periorbital and orbital cellulitis in children 4.
- Oral antibiotics, such as ciprofloxacin and clindamycin, may also be effective in the management of orbital cellulitis, especially in cases where intravenous therapy is not necessary 5.
Alternative Treatment Options
- Vancomycin may be considered as an alternative treatment option for orbital cellulitis resistant to Augmentin, as it has been shown to be effective against methicillin-resistant Staphylococcus aureus (MRSA) 2, 3.
- Amikacin may also be considered as an alternative treatment option, as it has been shown to have no resistance in bacterial susceptibility tests 3.
- Surgical intervention may be necessary in some cases of orbital cellulitis, especially if there is a significant collection of pus or if the infection is not responding to antibiotic therapy 4, 5.