First line (if patient at low risk of C. difficile infection*):

Co-amoxiclav oral 625mg 8 hourly for 7 days

First line (if patient at high risk of C. difficile infection*):

Flucloxacillin oral 500mg 6 hourly for 7 days

and

Metronidazole oral 400mg 8 hourly for 7 days

First line (if penicillin / beta-lactam allergy):

Doxycycline oral 100mg 12 hourly for 7 days

N.B. In pregnant patients doxycycline is contraindicated.

Second line (if penicillin / beta-lactam allergy):

Levofloxacin oral 500mg 12 hourly for 7 days

and

Metronidazole oral 400mg 8 hourly for 7 days

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

Note that levofloxacin is an agent with a higher risk of causing C. difficile infection.*

Suspect orbital cellulitis if there is evidence of skin and soft tissue infection in the eye area with peri-orbital oedema, a displaced globe, double vision, ophthalmoplegia, or reduced visual acuity.

This is an emergency, as it is potentially sight-threatening, and any suspected case should be referred to secondary care for assessment and treatment.

In the ED: all cases of facial/peri-orbital cellulitis should be discussed with a senior member of ED medical staff and a maxillo-facial surgeon or ophthalmologist.