What are the appropriate antibiotic choices for managing orbital cellulitis in adults and children?

Appropriate antibiotic choices for managing orbital cellulitis in both adults and children involve prompt initiation of empirical intravenous antibiotics targeting common causative organisms such as Staphylococcus aureus, Streptococcus species, and Haemophilus influenzae.

In adults, intravenous flucloxacillin is typically first-line to cover Staphylococcus aureus, including beta-lactamase producing strains, combined with a second agent such as a cephalosporin or metronidazole if anaerobic coverage is needed. For penicillin-allergic patients, alternatives include clindamycin or clarithromycin. The intravenous route is preferred initially, with review at 48 hours to consider switching to oral antibiotics if clinical improvement occurs NICE NG19.

In children, empirical intravenous antibiotics should cover similar pathogens, with particular attention to Haemophilus influenzae type b in unvaccinated children. Common regimens include intravenous ceftriaxone or cefotaxime, often combined with flucloxacillin or clindamycin to cover Staphylococcus aureus and anaerobes. Oral step-down therapy is considered once clinical improvement is evident Anosike et al. 2022.

Both adults and children with suspected or confirmed orbital cellulitis require hospital admission for intravenous therapy and close monitoring due to the risk of complications such as abscess formation and vision loss Howe & Jones 2004. The choice of antibiotics should be guided by local microbiology and specialist advice, especially if Pseudomonas aeruginosa or resistant organisms are suspected, where agents like piperacillin-tazobactam or ciprofloxacin may be considered with caution due to side effect profiles NICE NG19.

Overall, the management strategy integrates UK guideline principles of initial intravenous broad-spectrum antibiotics with clinical reassessment and step-down to oral therapy, supported by literature emphasizing pathogen coverage and the need for specialist input in children Anosike et al. 2022Howe & Jones 2004.