Orbital Cellulitis

Micro-organism

Streptococcus spp., Staphylococcus aureus

Duration

10 days but seek specialist advice

Notes
  • Serious emergency – infection of soft tissue behind orbital septum.
  • Contact specialist for advice if there is evidence of intracranial extension or if the patient has had surgery.
Orbital cellulitis – first line

IV Ceftriaxone 2g 12 hourly

+ Oral Metronidazole 400mg 8 hourly (or IV 500mg 8 hourly if oral route not available)

For 10 days total treatment – if intracranial pathology excluded and patient responds well to IV, then switch after 3-5 days to

Oral Co-amoxiclav 625mg 8 hourly

Orbital cellulitis - in severe penicillin allergy

 IV Co-trimoxazole* 960mg 12 hourly

+ IV Clindamycin 300mg 6 hourly

For 10 days total treatment - If intracranial pathology excluded and patient responds well to IV, then switch after 3-5 days to

Oral Co-trimoxazole 960mg 12 hourly

+ Oral Clindamycin 300mg 6 hourly

*If IV Co-trimoxazole not available use IV Ciprofloxacin 400mg twice daily