Our experience using primary oral antibiotics in the management of orbital cellulitis in a tertiary referral centre

Eye (Lond). 2009 Mar;23(3):612-5. doi: 10.1038/eye.2008.44. Epub 2008 Feb 29.

Abstract

Aims/purpose: Orbital cellulitis is conventionally managed by intravenous (i.v.) antibiotic therapy, followed by oral antibiotics once the infection shows signs of significant improvement. We report 4 years of experience using primary oral ciprofloxacin and clindamycin in cases of orbital cellulitis. Oral ciprofloxacin and clindamycin have a similar bioavailability to the i.v. preparations and provide an appropriate spectrum of antibiotic cover for the pathogens responsible for orbital cellulitis.

Methods: A retrospective review was performed that identified all patients with orbital cellulitis and treated with primary oral antibiotic therapy admitted to the Manchester Royal Eye Hospital between March 2003 and March 2007. Age, stage of disease, surgical intervention, hospital duration, and complications were obtained. A comparison was made with patients admitted to our unit with orbital cellulitis and treated with primary i.v. antibiotics between March 2000 and March 2003.

Results: Nineteen patients were included in the review for the period March 2003 to March 2007, which comprised of 7 children and 12 adults. Five patients required surgical intervention. All patients responded to the oral regimen, 18 patients had no change to their oral antibiotic therapy. Mean hospital stay was 4.4 days. There were no complications.

Discussion: Empirical oral ciprofloxacin and clindamycin combination may be as safe and effective as i.v. therapy in the management of orbital cellulitis. Oral treatment can offer the advantages of rapid delivery of the first antibiotic dose, fewer interruptions in treatment, and simplified delivery of medication particularly in children.

MeSH terms

  • Administration, Oral
  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / adverse effects
  • Child
  • Child, Preschool
  • Ciprofloxacin / administration & dosage
  • Ciprofloxacin / adverse effects
  • Clindamycin / administration & dosage
  • Clindamycin / adverse effects
  • Drug Therapy, Combination
  • Eye Infections, Bacterial / drug therapy*
  • Eye Infections, Bacterial / surgery
  • Humans
  • Infant
  • Injections, Intravenous
  • Middle Aged
  • Orbital Cellulitis / drug therapy*
  • Orbital Cellulitis / surgery
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Clindamycin
  • Ciprofloxacin