Mild

Amoxicillin/clavulanate 

Amoxycillin component:

Suspension (Formulation 14:1)

Amoxicillin / Clavulanate 80-90mg/kg/day PO in 2 divided doses (max. amoxicillin 2g/day)

Suspension (Formulation 7:1)

Amoxicillin / Clavulanate 40-45mg/kg/day PO in 2 divided doses (max. amoxicillin 2g/day)

Systemically Unwell

Cloxacillin 200mg/kg/day IV in 4 divided doses (max. 12g/day)

PLUS

Cefotaxime 150-200mg/kg/day IV in 3 divided doses (max. 6g/day)

OR

Ceftriaxone 50mg/kg/dose IV q12h (max. 4g/day)

Cephalexin 25-50mg/kg/day PO in 2 divided doses (max. 2g/day) for 10 days

Failure to respond within 24-48 hours may indicate orbital cellulitis or underlying sinus disease.

When improving and no organism identified, change to amoxicillin/clavulanate and complete for 7 days. 

Ceftriaxone 50mg/kg/dose IV q12h (max. 4g/day) for 7-14 days

PLUS

Cloxacillin 200mg/kg/day IV in 4 divided doses (max. 12g/day) for 7-14 days

**If associated with chronic sinusitis / complicated with intracranial abscess, to add on IV Metronidazole 30mg/kg/day q8hr (max. 1500mg/day)

Inpatient:

48-72 hours IV antibiotic, then oral to complete 14 days following good response (no positive culture)

Amoxicillin/clavulanate 

Amoxycillin component:

Suspension (Formulation 14:1)

Amoxicillin / Clavulanate 90mg/kg/day PO in 2 divided doses (max. amoxicillin 2g/day)

Suspension (Formulation 7:1)

Amoxicillin / Clavulanate 45mg/kg/day PO in 2 divided doses (max. amoxicillin 2g/day)

Antibiotic allergy:

Clindamycin 30-40mg/kg/day PO in 3 or 4 divided doses (max. 450mg/dose)

CA-MRSA:

Adjust accordingly with sensitivity

E.g.: Vancomycin 60mg/kg/day IV in 3-4 divided doses 

This condition is considered a surgical emergency and requires immediate consultation with ENT surgeon and ophthalmologist. 

Urgent CT scan needed to exclude associated abscess and intracranial extension.

Urgent surgical drainage of the ethmoid sinuses or of an orbital, subperiosteal or intracranial abscess may be needed.

Refer to Appendix 3 for antibiotic allergy.