OCULAR INFECTIONS
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Infection/Condition and Likely Organism |
Suggested Treatment |
Comments |
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Preferred Treatment |
Alternative Treatment |
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Preseptal cellulitis Streptococcus pneumoniae Staphylococcus aureus Streptococcus pyogenes Haemophilus influenzae |
Mild: Amoxicillin-clavulanate 45mg/kg/day PO in 2 divided doses Systemically unwell: Cloxacillin 200mg/kg/day (max. 2g/dose) IV in 4 divided doses PLUS Cefotaxime 150-200mg/ kg/day (max. 2gm/dose) IV in 3 divided doses OR Ceftriaxone 50mg/kg/dose (max. 2gm/dose) IV q12h |
Cephalexin 25-50mg/kg/ day PO in 2 divided doses for 10 days |
Failure to respond within 24-48 hours may indicate orbital cellulitis or underlying sinus disease. When improving and no organism identified, change to Amoxicillin-clavulanate and complete for 7 days. |
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Orbital cellulitis/abscess Streptococcus pyogenes Streptococcus pneumoniae Staphylococcus aureus Haemophilus influenzae |
Ceftriaxone 50mg/kg/ dose (max. 2gm) IV q12h for 7-14 days PLUS Cloxacillin 200mg/kg/day (max. 12gm) IV in 4 divided doses for 7-14 days Inpatient: 48-72 hours IV antibiotic, then oral to complete 14 days following good response or positive culture) |
Penicillin allergy: Clindamycin 30-40mg/kg/ day PO in 3 or 4 divided doses Also for CA-MRSA (adjust accordingly with antibiogram) |
It is a surgical emergency and requires immediate consultation with ENT surgeon and ophthalmologist. Urgent CT scan needed to exclude associated abscess and intracranial extension. Urgent surgical drainage of the ethmoid sinuses or of an orbital, subperiosteal or intracranial abscess may be needed. |