Periorbital Cellulitis (Preseptal Cellulitis) Organism-Specific Therapy 

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Organism-specific therapeutic regimens for the most common organisms responsible for periorbital cellulitis (also known as preseptal cellulitis), including those for Haemophilus influenzae, methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S aureus (MRSA), streptococcal species, and anaerobes, are provided below. ^[1]

For empiric therapy, see Periorbital Cellulitis Empiric Therapy.

Therapeutic regimens for H influenzae periorbital cellulitis are listed below.

Amoxicillin-clavulanate (see age-based dosing regimens below)

Cefpodoxime (see age-based dosing regimens below)

Cefdinir (see age-based dosing regimens below)

Ceftriaxone (see age-based dosing regimens below)

Therapeutic regimens for MSSA periorbital cellulitis are listed below.

Ampicillin-sulbactam 1.5-3 g IV q6h for 10-14 days or

Amoxicillin-clavulanic acid (see age-based dosing regimens below)

Cefuroxime (see age-based dosing regimens below)

Ceftriaxone (see age-based dosing regimens below)

Clindamycin (see age-based dosing regimens below)

Therapeutic regimens for MRSA periorbital cellulitis are listed below.

Vancomycin (see age-based dosing regimens below)

Daptomycin 4-6 mg/kg IV q24h ^[3]  or 

Clindamycin (see age-based dosing regimens below)

Trimethoprim-sulfamethoxazole (see age-based dosing regimens below)

Doxycycline (see age-based dosing regimens below)

Therapeutic regimens for streptococcal periorbital cellulitis are listed below.

Vancomycin (see age-based dosing regimens below)

Trimethoprim-sulfamethoxazole (see age-based dosing regimens below)

Amoxicillin (see age-based dosing regimens below)

​Amoxicillin-clavulanic acid (see age-based dosing regimens below)

Ceftriaxone (see age-based dosing regimens below)

​Erythromycin (see age-based dosing regimens below)

Therapeutic regimens for anaerobic periorbital cellulitis are listed below.

Piperacillin/tazobactam (see age-based dosing regimens below)

​Amoxicillin-clavulanic acid (see age-based dosing regimens below)

​Metronidazole (see age-based dosing regimens below)

Clindamycin (see age-based dosing regimens below)

Imipenem/cilastatin (see age-based dosing regimens below)

Chloramphenicol (see age-based dosing regimens below)

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. ^[6]

The most common organisms associated with periorbital cellulitis include Streptococcus pneumoniae, Staphylococcus aureus, other streptococcal species, and anaerobes. ^{[8, 9]}

Clinical improvement should occur within 24-48 hours.. If the patient worsens, consider an underlying orbital process or resistant organism(s). In some cases, the treatment duration depends on disease severity.

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

Surgical drainage is indicated only for abscesses and is usually unnecessary for uncomplicated periorbital cellulitis. ^{[1, 10, 11, 12]}

Wald ER. Periorbital and orbital infections. Infect Dis Clin North Am. 2007 Jun. 21(2):393-408, vi. [Medline].

Singleton R, Hammitt L, Hennessy T, Bulkow L, DeByle C, Parkinson A, et al. The Alaska Haemophilus influenzae type b experience: lessons in controlling a vaccine-preventable disease. Pediatrics. 2006 Aug. 118 (2):e421-9. [Medline]. [Full Text].

Wald ER. Periorbital and orbital infections. Pediatr Rev. 2004 Sep. 25(9):312-20. [Medline].

[Guideline] Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011 Feb 1. 52 (3):e18-55. [Medline]. [Full Text].

Koh E, Kim S. Decline in erythromycin resistance in group A Streptococci from acute pharyngitis due to changes in the emm Genotypes rather than restriction of antibiotic use. Korean J Lab Med. 2010 Oct. 30 (5):485-90. [Medline]. [Full Text].

Aldridge KE, Ashcraft D, Cambre K, Pierson CL, Jenkins SG, Rosenblatt JE. Multicenter survey of the changing in vitro antimicrobial susceptibilities of clinical isolates of Bacteroides fragilis group, Prevotella, Fusobacterium, Porphyromonas, and Peptostreptococcus species. Antimicrob Agents Chemother. 2001 Apr. 45 (4):1238-43. [Medline]. [Full Text].

Brook I. Treatment of anaerobic infection. Expert Rev Anti Infect Ther. 2007 Dec. 5 (6):991-1006. [Medline]. [Full Text].

Botting AM, McIntosh D, Mahadevan M. Paediatric pre- and post-septal peri-orbital infections are different diseases. A retrospective review of 262 cases. Int J Pediatr Otorhinolaryngol. 2008 Mar. 72 (3):377-83. [Medline]. [Full Text].

Chaudhry IA, Shamsi FA, Elzaridi E, Al-Rashed W, Al-Amri A, Arat YO. Inpatient preseptal cellulitis: experience from a tertiary eye care centre. Br J Ophthalmol. 2008 Oct. 92 (10):1337-41. [Medline]. [Full Text].

Brook I. Microbiology of acute sinusitis of odontogenic origin presenting with periorbital cellulitis in children. Ann Otol Rhinol Laryngol. 2007 May. 116(5):386-8. [Medline].

Lazzeri D, Lazzeri S, Figus M, et al. Periorbital necrotising fasciitis. Br J Ophthalmol. 2010 Dec. 94(12):1577-85. [Medline].

Mathew AV, Craig E, Al-Mahmoud R, Batty R, Raghavan A, Mordekar SR, et al. Paediatric post-septal and pre-septal cellulitis: 10 years’ experience at a tertiary-level children’s hospital. Br J Radiol. 2014 Jan. 87(1033):20130503. [Medline]. [Full Text].

Charalampidou S, Connell P, Fennell J, et al. Preseptal cellulitis caused by community acquired methicillin resistant Staphylococcus aureus (CAMRSA). Br J Ophthalmol. 2007 Dec. 91(12):1723-4. [Medline]. [Full Text].

T Amerson Pegram, MD Fellow in Ophthalmic Plastic and Reconstructive Surgery, Eyeplastx

T Amerson Pegram, MD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Periorbital Cellulitis (Preseptal Cellulitis) Organism-Specific Therapy 

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