Pre-septal peri-orbital cellulitis - Outpatient Treatment

Duration

7 Days

First Line - if patient at low risk of C.difficile infection

Important: Therapy

Co-amoxiclav PO 625mg three times daily

Notes:

 

Major risk factors for 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).

First line - if patient at high risk of C.difficile infection

Important: Therapy

Flucloxacillin PO 500mg every 6 hours 

plus

Metronidazole PO 400mg every 8 hours

Notes:

Major risk factors for 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).

First line - Adults with Penicillin allergy

Important: Therapy

Doxycycline PO 100mg every 12 hours

Notes:

In pregnant patients doxycycline is contraindicated. 

Second line - Adults with Penicillin allergy

Important: Therapy

Levofloxacin PO 500mg every 12 hours

plus

Metronidazole PO 400mg every 8 hours  

Notes:

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.

 Major risk factors for 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).

Important: Notes

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.