Orbital Cellulitis: The Daily PANCE Blueprint
Which of the following is the best antibiotic regimen for a patient with MRSA risk factors and severe orbital cellulitis of odontogenic origin?
A. Cefotxamine and clindamycin
B. Cefepime, clindamycin, and metronidazole
C. Ceftriaxone and linezolid
D. Cefotaxime and doxycycline
E. Ceftriaxone, metronidazole, and vancomycin
Answer and topic summary
The answer is E. Ceftriaxone, metronidazole, and vancomycin
Orbital cellulitis is an ophthalmic emergency, as it can lead to vision loss. Clinical features include diplopia, decreased vision, pain during eye movement, proptosis, erythematous, edematous eyelid, and fever. The most common bacterial culprits are Staphylococcus aureus and Streptococci species. The ethmoid sinus is the most common origin of infection (90% of the time). The best diagnostic test is a high-resolution CT scan. Treatment includes intravenous antibiotics, preferably intravenous that cover gram-positive and gram-negative bacteria (ceftriaxone or cefotaxime) and anaerobic bacteria (metronidazole or clindamycin), especially if there’s a suspicion of odontogenic origin of infection. If the patient has MRSA risk factors, vancomycin or linezolid can be added.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint EENT ⇒ ⇒
Also covered as part of the Emergency Medicine EOR, Family Medicine EOR, and Pediatric PAEA EOR topic list
