![]() Orbital infections: five-year case series, literature review and guideline development. after 24–48 hrs of IV antibiotics and with improvement.Child requires care above the level of comfort of local hospitalįor emergency advice and paediatric or neonatal ICU.Suspecting intracranial involvement with altered conscious state, seizures or focal neurological signs.Severe periorbital cellulitis or orbital cellulitis present.No improvement or deterioration after 24–48 hrs of therapy.Moderate-severe periorbital cellulitis present.Cefalexin 33 mg/kg (max 1 g) oral tds ORģ months – 2 years: 10 mg/kg (max 125 g) oral bd 2 – 12 years: 15 mg/kg (max 250 mg) oral bdĬonsultation with local paediatric team when.When improving, switch to oral antibiotics as per mild periorbital cellulitis Trimethoprim with sulfamethoxazole (8/40 mg/mL) 4/20 mg/kg (max 320/1600 mg) oral bdĭuration based on clinical severity and improvement.Clindamycin 15 mg/kg (max 600 mg) IV/oral 8 hourly OR.Usually at leastĪmoxicillin with clavulanic acid (doses based on amoxicillin component) 22.5 mg/kg (max 875 mg) oral bdįlucloxacillin 50 mg/kg (max 2g) IV 6 hourlyĬeftriaxone 50 mg/kg (max 2g) IV daily (consider HITH) If suspected MRSA: vancomycin (see link for dosing)ĭuration based on clinical severity and improvement. Ceftriaxone 50 mg/kg (max 2 g) IV dailyįlucloxacillin 50 mg/kg (max 2g) IV 6 hourly OR.Cefotaxime 50 mg/kg (max 2 g) IV 6 hourly OR.If not improving or deteriorating within 24–48 hours, consider managing as severe periorbital cellulitis.Once improving change to oral antibiotics.Consider blood culture if febrile and unwell.Inpatient management or consider Hospital In The Home (HITH) admission if available locally Inpatient investigations and management as per orbital cellulitis Treat underlying sinus disease eg nasal decongestants, steroids (often guided by ENT).Lumbar Puncture (LP) is contraindicated due to risk of raised intracranial pressure (ICP) secondary to possible intracranial extension.Consider urgent contrast enhanced CT scan of orbits, sinuses +/- brain.Seek ENT and Ophthalmology advice urgently.Keep fasted until need for surgery clarified.Haemophilus influenzae type B (Hib) vaccination, treat as severe periorbital cellulitis ![]() Severe headache or other features of intracranial involvementīilateral findings and/or painless (or non-tender) swelling in a well looking child is more likely to be an allergic reactionĪntimicrobial recommendations may vary according to local antimicrobial susceptibility patterns please refer to local guidelines these may include advice regarding community acquired MRSA.Unilateral eyelid swelling and erythemaĬonsider gonorrhoea and Chlamydia infections in neonatal presentation (send PCR swabs) see Acute red eye Red flags concerning for orbital.Typical presentation of periorbital/orbital cellulitis The globe is not involved in either infection.Not involving the orbit (ie preseptal, the structures anterior infection of the eye lids and surrounding skin.the majority (>80%) of cases relate to local.Including loss of vision, abscess formation, venous sinus thrombosis andĮxtension to intracranial infection with subdural empyema, and meningitis surgical emergency with major complications.The structures posterior to the orbital septum) infection within the orbit, (ie postseptal,.Periorbital and orbital cellulitis are distinct clinical diseases, though have overlapping clinical features and therefore can be difficult to differentiate.Periorbital cellulitis in a well child can often be treated with oral antibiotics if follow-up is assured.Urgent imaging and surgical consultation (ENT and ophthalmology) should be considered for any child with suspected orbital cellulitis.Orbital cellulitis is an emergency with serious complications including intracranial infection, cavernous sinus thrombosis and vision loss.Febrile child Sepsis Local antimicrobial guidelines Key points
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |