Need for drainage/source control of head and neck infections should be evaluated carefully in consultation with Pediatric Otolaryngology, Head and Neck Surgery. If initial non-operative management is chosen, a narrow spectrum regimen (i.e. without vancomycin), is encouraged to facilitate transition to oral therapy.
ID consultation is recommended for head and neck infections occcurring in immunocompromised patients, and for those with atypical features, chronic course, or lack of response to first line therapy.
| Condition | Major Pathogens | First Choice Therapy | Alternative Therapy | Comments |
|---|---|---|---|---|
| Orbital cellulitis/abscess |
Streptococci Staphylococcus aureus Haemophilus influenzae Anaerobes |
Ampicillin-sulbactam (Unasyn) 50 mg ampicillin/kg/dose (max 2000 mg ampicillin/dose) IV q6h If there is a large abscess (>10mm), anticipated to undergo surgical drainage, toxic appearance, rapidly progressive proptosis or ophthalmoplegia, or patient with history of documented MRSA infection or carriage within the last 6 months: ADD Vancomycin (follow link for dosing and monitoring) |
Penicillin or cephalosporin allergy with higher risk for allergic reaction: Consult ID/ASP |
Urgent OHNS and Ophthalmology consults recommended to evaluate need for source control ID consult recommended (see details above) For intracranial extension, refer to Intracranial Abscess section for empiric therapy Therapy may be tailored based on cultures from I&D. If Vancomycin was started but MRSA not recovered, Vancomycin should be discontinued. Duration: Uncomplicated orbital cellulitis/abscess is typically treated first with IV therapy then converted to enteral therapy within days based on clinical improvement, with a total duration of 14-21 days (combined IV and enteral). A longer duration may be indicated if there is significant bone destruction or a large abscess that is not drained. |
References:
Seltz LB, et al. Microbiology and antibiotic management of orbital cellulitis. Pediatrics 2011;127:e566-e572.
American Academy of Pediatrics. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2021.