Orbital cellulitis medical therapy: Difference between revisions
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Orbital cellulitis is considered an ophthalmological emergency.Prompt treatment is vital for a patient when fighting orbital cellulitis. Treatment typically involves IV antibiotics in the hospital and frequent observation (every 4-6 hours). Along with this several laboratory tests are run including a complete blood count, differential, and blood culture. | Orbital cellulitis is considered an ophthalmological emergency.Prompt treatment is vital for a patient when fighting orbital cellulitis. Treatment typically involves IV antibiotics in the hospital and frequent observation (every 4-6 hours). Along with this several laboratory tests are run including a complete blood count, differential, and blood culture. | ||
==Medical Therapy== | ==Medical Therapy== | ||
* ''' | *'''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 (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 | ||
| Line 19: | Line 25: | ||
:*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''' | ||
:*''' | :*'''3.1 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''' | ||
::*Preferred regimen (1): [[Ampicillin]]/[[Sulbactam]] 3 g IV q6h for 1 week | ::*Preferred regimen (1): [[Ampicillin]]/[[Sulbactam]] 3 g IV q6h for 1 week | ||
| Line 32: | Line 38: | ||
::*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 | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 17:54, 12 August 2015
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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]
Overview
Because of concern for spread of infection, patients must be admitted to the hospital to receive intravenous antibiotics. Orbital cellulitis is considered an ophthalmological emergency.Prompt treatment is vital for a patient when fighting orbital cellulitis. Treatment typically involves IV antibiotics in the hospital and frequent observation (every 4-6 hours). Along with this several laboratory tests are run including a complete blood count, differential, and blood culture.
Medical Therapy
- 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
- 3.1 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 (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