Periorbital Cellulitis (Preseptal Cellulitis) Organism-Specific Therapy 

Updated: Jun 09, 2022
  • Author: Jonathan C Tsui, MD; Chief Editor: Thomas E Herchline, MD  more...
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Specific Organisms and Therapeutic Regimens

Organism-specific therapeutic regimens for the most common organisms responsible for periorbital cellulitis (also known as preseptal cellulitis) are provided below. [1]  Local antibiograms should be consulted in addition to the following guidelines below for methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S aureus (MRSA), streptococcal species, Haemophilus influenzae, and anaerobes.

For empiric therapy, see Periorbital Cellulitis (Preseptal Cellulitis) Empiric Therapy.

Methicillin-susceptible Staphylococcus aureus (MSSA) periorbital cellulitis

Ampicillin-sulbactam

  • 1.5-3 g IV q6h for 10-14 days 

Pediatric

  • 100-200mg/kg/dose IV of ampicillin component q6h (max: 2g/dose) OR

Amoxicillin-clavulanic acid 

Pediatric

  • 45-90 mg/kg/day PO divided q12h for 10-14 days

Adult

  • 875 mg PO q12h for 10-14 days  OR

Cefuroxime 

Children aged 3 months or older

  • 50-100 mg/kg/day IM/IV divided q8h for 10-14 days (maximum 9 g/day)

Adult

  • 1.5 g IV q8h for 10-14 days OR

Ceftriaxone 

Pediatric

  • 50-100 mg/kg/day IM/IV divided q12h (maximum 4 g/day)

Adult

  • 1 g IV daily for 10-14 days  OR

Clindamycin 

Pediatric

  • IV: 20-40 mg/kg/day IV divided q6-8h; max 900 mg/dose given IV
  • PO: 20-30 mg/kg/day PO divided q6-8h; max 450 mg/dose given PO

Adult

  • 600 mg IV/PO q8h for 10-14 days

Methicillin-resistant Staphylococcus aureus (MRSA) periorbital cellulitis

Vancomycin 

Age 1 month to 11 years

  • 10-15 mg/kg IV q6-8h (maximum 1 g per dose)

Older than 12 years

  • 1 g (15 mg/kg) IV q12h for 7-10 days  OR

Daptomycin 

  • 4-6 mg/kg IV q24h [2]   OR 

Clindamycin

Pediatric

  • 10–13 mg/kg/dose PO every 6–8 h, not to exceed 40 mg/kg/day [3]

Adult

  • 600 mg IV/PO q8h for 10-14 days [4]   OR

Trimethoprim-sulfamethoxazole

Pediatric

  • Trimethoprim 8-10 mg/kg/day PO/IV divided q12h for 10 days

Adult

  • Trimethoprim 160 mg PO q12h for 10 days  OR

Doxycycline 

Children older than 8 years

  • 2-4 mg/kg/day PO divided q12h for 7-10 days

Adult

  • 100 mg PO/IV q12h for 1 day, then 100 mg PO/IV q24h for 10-14 days

Streptococcal periorbital cellulitis

Vancomycin 

Age 1 month to 11 years

  • 10-15 mg/kg IV q6-8h (maximum 1 g/dose)

Older than 12 years

  • 1 g (10-15 mg/kg) IV/PO q12h for 7-10 days  OR

Trimethoprim-sulfamethoxazole 

Pediatric

  • Trimethoprim 8-10 mg/kg/day PO/IV divided q12h for 10 days

Adult

  • Trimethoprim 160 mg PO q12h for 10 days  OR

Amoxicillin 

Pediatric

  • 80-100 mg/kg/day PO divided q12h for 10 days (maximum 500 mg/dose)

Adult

  • 875 mg PO q24h for 10-14 days  OR

Amoxicillin-clavulanic acid

Pediatric

  • 45 mg/kg/day PO divided q12h for 10-14 days

Adult

  •  875 mg PO q12h for 10-14 days  OR

Ceftriaxone 

Pediatric

  • 50-100 mg/kg/day IM/IV divided q12h (maximum 4 g/day)

Adult

  • 1 g IV daily for 10-14 days OR 

Erythromycin

Pediatric

  • 30-50 mg/kg/day PO divided q6-8h for 7-10 days (maximum 4 g/day)

Adult

  • 500 mg/day PO q6h for 10-14 days [5]

Haemophilus influenzae periorbital cellulitis

Amoxicillin-clavulanate 

Pediatric

  • 45-90 mg/kg/day PO divided q12h for 10-14 days

Adult

  • 875 mg PO q12h for 10-14 days  OR 

Cefpodoxime 

Pediatric

  • 10 mg/kg/day PO divided q12h for 10 days

Adult

  • 200-400 mg PO q12h for 10-14 days  OR

Cefdinir 

Pediatric

  • 14 mg/kg/day PO divided q12h for 10 days (maximum 600 mg/day)

Adult

  • 600 mg PO daily for 10-14 days  OR

Ceftriaxone 

Pediatric

  • 50-100 mg/kg/day IM/IV

Adult

  • 1-2 g IM/IV q24h [6]

Anaerobic periorbital cellulitis

Piperacillin/tazobactam 

Age 2-9 months

  • 240 mg/kg/day IV divided q8h for 7-10 days

Older than 9 months

  • 3.375 g IV q6h for 7-10 days OR

Amoxicillin-clavulanate 

Pediatric

  • 45 mg/kg/day PO divided q12h for 10-14 days

Adult

  • 875 mg PO q12h for 10-14 days  OR

Metronidazole 

Pediatric

  • 30 mg/kg/day PO/IV divided q6h for 10-14 days (maximum 4 g/day)

Adult

  • 500 mg PO q6-8h for 10-14 days (maximum 1 g/dose) [7]   OR

Clindamycin

Pediatric

  • 30-40 mg/kg/day IV divided q8h for 10-14 days (maximum 1.8 g/day)

Adult

  • 300 mg IV q8h for 10-14 days [8]   OR

Imipenem/cilastatin

Pediatric

  • 60-100 mg/kg/day IV divided q6h (maximum 2-4 g/day)

Adult

  • 1 g IV q8h (maximum 50 mg/kg/day up to 3 g/day)  OR

Chloramphenicol

Pediatric

50-75 mg/kg/day IV divided q6h (maximum 4 g/day)

Adult

50-100 mg/kg/day IV divided q6h (maximum 100 mg/kg/day)

Special considerations

Periorbital cellulitis is a common infection of the eyelid and periorbital soft tissues characterized by acute eyelid erythema and edema.

This bacterial infection usually results from the local spread of an adjacent upper respiratory tract infection, adjacent sinusitis, or an external ocular infection or following trauma to the eyelids. [7]

The most common organisms associated with periorbital cellulitis include Streptococcus pneumoniae, Staphylococcus aureus, other streptococcal species, and anaerobes. [9, 10]

Clinical improvement should occur within 24-48 hours with antibiotic therapy. If the patient worsens, consider an underlying orbital or sinus process, drug allergy, resistant organism(s), and need for hospitalization. In some cases, the treatment duration depends on disease severity.

The condition initially should be treated as orbital cellulitis in children younger than 1 year, patients who are difficult to examine, and patients who are immunocompromised.

Surgical drainage is indicated only for abscesses and is usually unnecessary for uncomplicated periorbital cellulitis. Drainage specimens should be sent for cultures. [1, 11, 12, 13]

There are no recommendations that steroids should be considered routinely in periorbital cellulitis. [14]