Post Septal/Orbital Cellulitis

NHSL Antimicrobial Guidelines
NHS Lanarkshire

Duration

Liaise with Infection Specialist.

Post Septal/Orbital Cellulitis

Therapy

This is an emergency. Seek immediate specialist advice from Ophthalmology & ENT. Consider CT imaging & drainage.

 

IV Ceftriaxone 2g 24 hourly (or 12 hourly if intracranial extension) 
+ IV Flucloxacillin5, 10 1-2g 6 hourly 
+ Oral / IV Metronidazole12 400mg / 500mg 8 hourly

 

Penicillin intolerance/minor Penicillin allergy (see below for severe penicillin allergy/anaphylaxis)

IV Ceftriaxone 2g 24 hourly (or 12 hourly if intracranial extension) 
+ Oral / IV Metronidazole12 400mg / 500mg 8 hourly 

 

Clear history of anaphylaxis with Penicillin or severe/true Penicillin allergy

IV Vancomycin3
+ IV Ciprofloxacin 1,2,8,9,10 400mg 12 hourly 
+ Oral / IV Metronidazole12 400mg / 500mg 8 hourly

Notes:

Liaise with Infection Specialist.

Notes

Doses may need to be adjusted in renal impairment. Always check the BNF for interactions. Seek advice if patient pregnant.

Drug Specific Cautions:

  1. Check interactions in the BNF. Caution may prolong QT interval.
  2. Avoid / Caution in pregnancy or breastfeeding. Consult BNF for details.
  3. Gentamicin/Vancomycin refer to online calculators.
  4. ALERT Antibiotic - Consult Second line Policy on NHS Lanarkshire Guideline App.
  5. Monitor sodium.
  6. See CURB65 definition.
  7. Reference: The Renal Drug Handbook. Online access.
  8. See Fluoroquinolones MHRA guidance on NHS Lanarkshire Guidelines App.
  9. Doxycycline and quinolones decreased absorption with iron, calcium, magnesium and some nutritional supplements. See BNF appendix 1 or pharmacy for advice.
  10. Caution in renal impairment – see BNF or pharmacy for advice.
  11. Use with caution may increase K+ and decrease renal function. Monitor.
  12. High / Excellent oral bioavailability, IV route available for NBM or vomiting.
  13. See Co-trimoxazole information for prescribers’ safety sheet on NHS Lanarkshire Guidelines App.

Editorial Information

Last reviewed: 01/12/2022

Next review date: 01/12/2025

Author(s): NHS Lanarkshire Antimicrobial Management Committee, Dr Dundas, Dr Hylands, S McCormick.

Approved By: NHS Lanarkshire Antimicrobial Management Committee

Reviewer name(s): NHS Lanarkshire Antimicrobial Management Committee.

Document Id: March 2023