Pediatric Guidelines: Head and Neck Infections - Orbital Cellulitis

Need for drainage/source control of head and neck infections should be evaluated carefully in consultation with Pediatric Otolaryngology, Head and Neck Surgery, and Ophthalmology when the orbit is involved. If initial non-operative management is chosen, a narrow spectrum regimen (i.e. without vancomycin) is encouraged to faciliate transition to oral therapy. 

ID consultation is recommended for head and neck infections occurring 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

Staphyloccocus aureus


Haemophilus influenzae


Ampicillin-sulbactam (Unasyn) 50mg/kg/dose IV q6h (max 2g ampicillin/dose)

ADD Vancomycin for severe infection or suspicion of MRSA:

Age 3mo-<12yo: 17.5mg/kg/dose IV q6h (initial max 1g/dose)

Age >=12 yo: 15mg/kg/dose IV q6h (initial max 1g/dose)  

Severe beta lactam allergy:

Consult ID/ASP

OHNS, Ophthalmology and ID consults recommended

For intracranial extension, refer to Brain Abscess section for empiric therapy

Therapy may be tailored based on cultures from I&D

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).