Orbital cellulitis medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Orbital cellulitis}} | {{Orbital cellulitis}} | ||
{{CMG}} {{AE}} {{Faizan}} | {{CMG}}; {{AE}} {{Faizan}}; {{TarekNafee}} | ||
==Overview== | ==Overview== | ||
Orbital cellulitis is considered an | Orbital cellulitis is considered an ophthalmologic emergency. The mainstay of therapy for orbital cellulitis involves prompt intravenous [[Antimicrobial|antimicrobial therapy]] with either [[beta-lactam]]s or [[clindamycin]]. Patients suspected to have [[Methicillin resistant staphylococcus aureus|MRSA]]-induced orbital cellulitis require more extensive [[Antimicrobial|antimicrobial therapy]]. | ||
==Medical Therapy== | |||
===[[Antimicrobial]] Regimens=== | |||
*'''1. Causative [[pathogens]]''' | |||
*'''1. Causative pathogens''' | :*Methicillin-sensitive [[staphylococcus aureus]] | ||
:*Methicillin-sensitive staphylococcus aureus | :*[[Methicillin-resistant staphylococcus aureus]] | ||
:*Methicillin-resistant staphylococcus aureus | :*[[Staphylococcus epidermidis]] | ||
:*Staphylococcus epidermidis | :*[[Streptococcus]] spp. | ||
:*Streptococcus spp. | :*[[Moraxella]] spp. | ||
:*Moraxella spp. | :*[[Anaerobes]] | ||
:*Anaerobes | *'''2. Empiric [[Antimicrobial|antimicrobial therapy]]''' | ||
*'''2. Empiric antimicrobial therapy''' | |||
:*Preferred regimen (1): [[Ampicillin]]/[[Sulbactam]] 3 g IV q6h for 1 week | :*Preferred regimen (1): [[Ampicillin]]/[[Sulbactam]] 3 g IV q6h for 1 week | ||
:*Preferred regimen (2): [[Ceftriaxone]] 1-2 g IV q12h for 1 week | :*Preferred regimen (2): [[Ceftriaxone]] 1-2 g IV q12h for 1 week | ||
:*Preferred regimen (3): [[Clindamycin]] 300 mg IV q6h for 1 week | :*Preferred regimen (3): [[Clindamycin]] 300 mg IV q6h for 1 week | ||
:* Preferred regimen (4): [[Nafcillin]] 2 g IV q4h for 1 week {{and}} [[Ceftriaxone]] 2 g IV q24h for 1 week {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided in 3 doses for 1 week | :* Preferred regimen (4): [[Nafcillin]] 2 g IV q4h for 1 week {{and}} [[Ceftriaxone]] 2 g IV q24h for 1 week {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided in 3 doses for 1 week | ||
:* Alternative regimen (1), MRSA suspicion: [[Vancomycin]] 1 g IV q12h for 1 week {{and}} [[Ceftriaxone]] 2 g IV q24h for 1 week {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided q8h for 1 week | :* Alternative regimen (1), [[MRSA]] suspicion: [[Vancomycin]] 1 g IV q12h for 1 week {{and}} [[Ceftriaxone]] 2 g IV q24h for 1 week {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided q8h for 1 week | ||
:* Alternative regimen (2), MRSA suspicion: [[Vancomycin]] 1 g IV q12h for 1 week {{and}} [[Levofloxacin]] 750 mg IV q24h for 1 week {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided q8h for 1 week | :* Alternative regimen (2), [[MRSA]] suspicion: [[Vancomycin]] 1 g IV q12h for 1 week {{and}} [[Levofloxacin]] 750 mg IV q24h for 1 week {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided q8h for 1 week | ||
:*Alternative regimen (3), pediatric: [[Ampicillin]]/[[Sulbactam]] 200-300 mg/kg/d IV divided q6h for 1 week | :*Alternative regimen (3), pediatric: [[Ampicillin]]/[[Sulbactam]] 200-300 mg/kg/d IV divided q6h for 1 week | ||
:*Alternative regimen (4), pediatric: [[Ceftriaxone]] 100 mg/kg/d IV divided q12h for 1 week | :*Alternative regimen (4), pediatric: [[Ceftriaxone]] 100 mg/kg/d IV divided q12h for 1 week | ||
:*Alternative regimen (5), pediatric: [[Clindamycin]] 20-40 mg/kg/d IV divided q12 for 1 week | :*Alternative regimen (5), pediatric: [[Clindamycin]] 20-40 mg/kg/d IV divided q12 for 1 week | ||
:*Note (1): Oral antibiotic therapy may be extended beyond 2-3 weeks if the clinical presentation is consistent with either severe sinusitis or bony destruction | :*Note (1): Oral [[antibiotic therapy]] may be extended beyond 2-3 weeks if the clinical presentation is consistent with either severe [[sinusitis]] or bony destruction | ||
:*Note (2): Consider surgical intervention if the patient has either visual loss, complete ophthalmoplegia, large abscess > 1 cm, or no clinical improvement following 1-2 days of antibiotic administration | :*Note (2): Consider surgical intervention if the patient has either [[visual loss]], complete [[ophthalmoplegia]], large [[abscess]] > 1 cm, or no clinical improvement following 1-2 days of [[antibiotic]] administration | ||
*'''3. Pathogen-directed antimicrobial therapy''' | *'''3. [[Pathogen]]-directed antimicrobial therapy''' | ||
:*'''3.1 Methicillin-resistant staphylococcus aureus (MRSA)''' | :*'''3.1 [[MRSA|Methicillin-resistant staphylococcus aureus (MRSA)]]''' | ||
::*Preferred regimen (1): [[Vancomycin]] 1 g IV q12h for 1 week {{and}} [[Ceftriaxone]] 2 g IV q24h for 1 week {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided q8h for 1 week | ::*Preferred regimen (1): [[Vancomycin]] 1 g IV q12h for 1 week {{and}} [[Ceftriaxone]] 2 g IV q24h for 1 week {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided q8h for 1 week | ||
::*Preferred regimen (2): [[Vancomycin]] 1 g IV q12h for 1 week {{and}} [[Levofloxacin]] 750 mg IV q24h for 1 week {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided q8h for 1 week | ::*Preferred regimen (2): [[Vancomycin]] 1 g IV q12h for 1 week {{and}} [[Levofloxacin]] 750 mg IV q24h for 1 week {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided q8h for 1 week | ||
:*'''3.2 Non-MRSA organisms''' | :*'''3.2 Non-MRSA organisms''' | ||
::*Preferred regimen (1): [[Ampicillin]]/[[Sulbactam]] 3 g IV q6h for 1 week | ::*Preferred regimen (1): [[Ampicillin]]/[[Sulbactam]] 3 g IV q6h for 1 week | ||
::*Preferred regimen (2): [[Ceftriaxone]] 1-2 g IV q12h for 1 week | ::*Preferred regimen (2): [[Ceftriaxone]] 1-2 g IV q12h for 1 week | ||
::*Preferred regimen (3): [[Clindamycin]] 300 mg IV q6h for 1 week | ::*Preferred regimen (3): [[Clindamycin]] 300 mg IV q6h for 1 week | ||
::*Preferred regimen (4): [[Nafcillin]] 2 g IV q4h for 1 week {{and}} [[Ceftriaxone]] 2 g IV q24h for 1 week {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided in 3 doses for 1 week | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Ophthalmology]] | |||
[[Category:Emergency mdicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
Latest revision as of 23:26, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]; Tarek Nafee, M.D. [3]
Overview
Orbital cellulitis is considered an ophthalmologic emergency. The mainstay of therapy for orbital cellulitis involves prompt intravenous antimicrobial therapy with either beta-lactams or clindamycin. Patients suspected to have MRSA-induced orbital cellulitis require more extensive antimicrobial therapy.
Medical Therapy
Antimicrobial Regimens
- 1. Causative pathogens
- Methicillin-sensitive staphylococcus aureus
- Methicillin-resistant staphylococcus aureus
- Staphylococcus epidermidis
- Streptococcus spp.
- Moraxella spp.
- Anaerobes
- 2. Empiric antimicrobial therapy
- Preferred regimen (1): Ampicillin/Sulbactam 3 g IV q6h for 1 week
- Preferred regimen (2): Ceftriaxone 1-2 g IV q12h for 1 week
- Preferred regimen (3): Clindamycin 300 mg IV q6h for 1 week
- Preferred regimen (4): Nafcillin 2 g IV q4h for 1 week AND Ceftriaxone 2 g IV q24h for 1 week AND Metronidazole 30-35 mg/kg/d IV divided in 3 doses for 1 week
- Alternative regimen (1), MRSA suspicion: Vancomycin 1 g IV q12h for 1 week AND Ceftriaxone 2 g IV q24h for 1 week AND Metronidazole 30-35 mg/kg/d IV divided q8h for 1 week
- Alternative regimen (2), MRSA suspicion: Vancomycin 1 g IV q12h for 1 week AND Levofloxacin 750 mg IV q24h for 1 week AND Metronidazole 30-35 mg/kg/d IV divided q8h for 1 week
- Alternative regimen (3), pediatric: Ampicillin/Sulbactam 200-300 mg/kg/d IV divided q6h for 1 week
- Alternative regimen (4), pediatric: Ceftriaxone 100 mg/kg/d IV divided q12h for 1 week
- Alternative regimen (5), pediatric: Clindamycin 20-40 mg/kg/d IV divided q12 for 1 week
- Note (1): Oral antibiotic therapy may be extended beyond 2-3 weeks if the clinical presentation is consistent with either severe sinusitis or bony destruction
- Note (2): Consider surgical intervention if the patient has either visual loss, complete ophthalmoplegia, large abscess > 1 cm, or no clinical improvement following 1-2 days of antibiotic administration
- 3. Pathogen-directed antimicrobial therapy
-
- Preferred regimen (1): Vancomycin 1 g IV q12h for 1 week AND Ceftriaxone 2 g IV q24h for 1 week AND Metronidazole 30-35 mg/kg/d IV divided q8h for 1 week
- Preferred regimen (2): Vancomycin 1 g IV q12h for 1 week AND Levofloxacin 750 mg IV q24h for 1 week AND Metronidazole 30-35 mg/kg/d IV divided q8h for 1 week
- 3.2 Non-MRSA organisms
- Preferred regimen (1): Ampicillin/Sulbactam 3 g IV q6h for 1 week
- Preferred regimen (2): Ceftriaxone 1-2 g IV q12h for 1 week
- Preferred regimen (3): Clindamycin 300 mg IV q6h for 1 week
- Preferred regimen (4): Nafcillin 2 g IV q4h for 1 week AND Ceftriaxone 2 g IV q24h for 1 week AND Metronidazole 30-35 mg/kg/d IV divided in 3 doses for 1 week