Infection
Peri-orbital cellulitis (pre- and post-septal) - inpatient treatment
Antibiotic Therapy (before prescribing, carefully read the Notes / Comments section below)

Pre-septal peri-orbital cellulitis:

Flucloxacillin IV 1-2g 6 hourly

and

Benzylpenicillin IV 1.2-2.4g 6 hourly

If true penicillin / beta-lactam allergy or known MRSA:

Vancomycin IV (dosing info here)

and

Metronidazole IV 500mg 8 hourly

and

Levofloxacin oral 500mg 12 hourly (use IV route only if oral route is compromised)

In pregnant patients, levofloxacin is contraindicated - discuss appropriate empirical choices with an infection specialist.

Post-septal peri-orbital cellulitis:

Ceftriaxone IV 2g 12 hourly

and

Metronidazole IV 500mg 8 hourly

If true penicillin / beta-lactam allergy or known MRSA:

Vancomycin IV (dosing info here)

and

Metronidazole IV 500mg 8 hourly

and

Levofloxacin oral 500mg 12 hourly (use IV route only if oral route is compromised)

In pregnant patients, levofloxacin is contraindicated - discuss appropriate empirical choices with an infection specialist.

Note: Ceftriaxone does not cover P. aeruginosa - if pseudomonal cover is required discuss with an Infection Specialist. Both ceftriaxone and levofloxacin are agents with a higher risk of causing C. difficile infection. See below for additional risk factors, and discuss with an Infection Specialist if required.
Duration
7 days
Notes / Comments

Major risk factors for C. difficile infection (CDI):

Certain persons are at increased risk of acquiring CDI.

The possibility of CDI should be considered when persons with diarrhoea also have:

  • Current or recent (within the last three months) use of antimicrobial agents (especially those with a high risk for CDI, e.g. cephalosporins, broad spectrum penicillins, fluoroquinolones and clindamycin);
  • Increased age (>65 years old);
  • A previous diagnosis of CDI;
  • Prolonged hospital stay;
  • Serious underlying diseases;
  • Surgical procedures (in particular bowel procedures);
  • Immunosuppression (including HIV infection and transplant patients); and/or
  • Use of proton pump inhibitors (PPI)/H2 antagonists (drugs which reduce the production of stomach acid).

 

 

Guideline reviewed August 2023
Page updated March 2024



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