What is the best initial treatment for orbital cellulitis in children?
Steroids have no proven benefit
Systemic steroids have no proven benefit in the treatment of pediatric orbital cellulitis with subperiosteal abscess.
A small retrospective cohort study of the benefit of intravenous steroids in addition to antibiotics showed no decrease in hospital stay or need for surgical decompression (n=23, P=.26 and .20, respectively).9 Without prospective data and a power analysis, lack of benefit of steroids cannot be definitively shown.
Recommendations from others
Infectious Disease Society of America. The guidelines for the management of skin and soft-tissue infections implicate β-hemolytic streptococci as the most common cellulitis pathogen, but also recommend empiric coverage against S aureus.
Periorbital and orbital cellulitis are not specifically addressed in these guidelines, but oral dicloxacillin, cephalexin, clindamycin, or erythromycin are recommended for superficial cellulitis, provided there is no known resistance to these antibiotics.
Intravenous penicillinase-resistant penicillins (nafcillin) or a first-generation cephalosporin (cefazolin) may be used for more severe infections.
For penicillin-allergic patients, the IDSA recommends clindamycin or vancomycin.10
Sanford Guide to Antimicrobial Therapy. Nafcillin plus ceftriaxone and metronidazole is the recommended treatment for orbital cellulitis.
For patients allergic to penicillin, vancomycin plus levofloxacin and metronidazole are recommended.8
Neither the American Academy of Ophthalmology nor the International Council of Ophthalmology offers clinical statements on orbital cellulitis.
Acknowledgments
The opinions and assertions contained herein are the private views of the author and not to be construed as official, or as reflecting the views of the US Air Force Medical service or the US Air Force at large.
