J32.9
DIAGNOSTIC CRITERIA
Clinical
- Signs and symptoms of complications:
- Peri-orbital swelling and fever.
- Signs of meningeal irritation:
- Neck stiffness, positive Kernig’s and Brudzinski’s signs.
- Signs of increased intracranial pressure:
- Hypertension, bradycardia, papilloedema and headache.
- Signs of involvement of orbital structures:
- Periorbital oedema, erythema, chemosis, proptosis, vision loss and ophthalmoplegia.
- Signs of brain involvement:
- Neurological signs, ataxia, paresis, paralysis, convulsions and altered level of consciousness.
Investigations
- CT scan of brain, sinuses and orbits may show opacities and complications.
- CT scan will show if there is involvement of intracranial structures, e.g. brain abscess and intraorbital involvement.
- Pus, CSF and blood for culture and sensitivity tests. Microscopy and Gram-staining of pus and CSF specimens may give some indication of the micro-organism/s involved.
MEDICINE TREATMENT
Empiric antibiotic therapy
- Initiate empiric antibiotic therapy and reassess as soon as culture and sensitivity results become available or if there is no clinical improvement within 48–72 hours.
Total duration of therapy: 14 days.
- Ceftriaxone, IV, 50–80 mg/kg once daily
Refer to Chapter 16: Eye Conditions, Preseptal and Orbital Cellulitis .
As soon as there is a response and patient can tolerate oral medication:
- Amoxicillin/clavulanate, oral, 30 mg/kg/dose of amoxicillin component, 8 hourly.
Penicillin allergy
See Chapter 24: Drug Allergies, Allergies to penicillins .
For pain:
- Paracetamol, oral, 15 mg/kg/dose 6 hourly as required.
REFERRAL
Urgent
- Spread of infection to eye/orbital structures or intracranial structures/brain.