• Infectious Disease Medicine
• Microbiology
• Paediatrics
• Ophthalmology
• Child Health

Orbital cellulitis, infection of the soft tissues of the orbit posterior to the orbital septum, mostly occurs secondary to sinusitis, is usually caused by upper respiratory tract organisms and is most common in children. Orbital cellulitis has potentially devastating complications, including loss of visual acuity, cavernous sinus thrombosis, meningitis, intracranial abscess formation, septic embolus and rarely, death. Therefore, appropriate diagnosis and treatment is critical to prevent such complications. However, there is presently a limited evidence base for empiric antibiotic regimes in orbital cellulitis, with an absence of randomised trials or antimicrobial stewardship studies. This has led to diversity in antimicrobial practices, indications for surgery and varied lengths of stay that are influenced by outpatient parenteral antibiotic therapy (OPAT) availability.1 2 Investigation of temporal empiric antimicrobial practices and their relationship with clinical outcomes of orbital cellulitis in children have not been performed to date.

Krueger et al3 have built on their previous work in this area to report a multicentre cohort study of orbital cellulitis, with a specific focus on empiric antibiotic regimens and their relationship with outcomes. They did a retrospective analysis of the electronic health records of a very large Canadian paediatric population of 1421 children over 10 years (2009–2018).

To investigate the association of empiric intravenous antibiotic therapy for orbital cellulitis on outcomes, they categorised antibiotic therapy according to the backbone of a third-generation cephalosporin versus third-generation cephalosporin and additional dedicated broader antibiotic coverage, for example, plus anti-anaerobic (metronidazole) or anti-staphylococcal agents (vancomycin), or both. The study’s primary outcome was the length of hospital stay and the secondary outcome was the need for surgery.

Krueger et al rigorously performed stratification for the severity of orbital …