Patients at low risk of MRSA infection
For patients with periorbital cellulitis who are systemically unwell in whom orbital cellulitis has been excluded and who are at low risk of methicillin-resistant Staphylococcus aureus (MRSA) infection (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), use:
flucloxacillin 2 g (child: 50 mg/kg up to 2 g) intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see flucloxacillin intravenous dosage adjustment. See advice on patient review, and modification and duration of therapy. flucloxacillin flucloxacillin flucloxacillin
For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use:
cefazolin 2 g (child: 50 mg/kg up to 2 g) intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see cefazolin dosage adjustment. See advice on patient review, and modification and duration of therapy. cefazolin cefazolin cefazolin
For patients who have had a severe immediate1 hypersensitivity reaction to a penicillin, cefazolin (at the dosage above) can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).
For patients who have had a severe immediate1 hypersensitivity reaction to a penicillin in whom cefazolin is not used, or for patients who have had a severe delayed2 hypersensitivity reaction to a penicillin, use vancomycin (see Patients at increased risk of MRSA infection for dosage).