Oral co-amoxiclav (clindamycin if penicillin allergic), and the course should usually be 7-10 days. Clinical improvement should occur over 24-48 hours and ideally, a plan should be made for re assessment after this time period.
Take into account:
– Social circumstances.
– Skills and confidence of carer to care for the child and to spot red flag symptoms.
– Distance to healthcare facility in case of deterioration.
If there is no improvement or deterioration after 24-48 hours of therapy, contact the Paediatric Assessment Unit for same day assessment (via switchboard).
Moderate-severe (or if any suspicion of orbital cellulitis)
Refer immediately to hospital if:
- Suspicion of intracranial involvement (meningism, confusion, altered conscious level, severe headache) Please consider transfer via 999 ambulance.
- There is any suspicion of orbital cellulitis/ you are unable to fully assess eye movements due to swelling.
- All patients with features of either condition who are systemically unwell
- Any patient not responding to treatment for periorbital cellulitis
- Any abnormality of visual acuity, colour vision or abnormality of cranial nerve examination
- When drainage of a lid abscess is required
Please call on call paediatrics via switchboard to alert of referral – the child may be seen in the Paediatric Assessment Unit, or asked to attend A&E if they sound clinically very unwell as resuscitation facilities are more readily available there.
Hospital management may involve intravenous therapy (e.g. intravenous ceftriaxone until response is seen), and there is potential for this to be ambulatory if the child is well, examination is reassuring and social circumstances allow.
If there is a suspicion of orbital cellulitis, or physical examination is not reassuring, further investigations may include CT imaging of brain and orbits.
Ophthalmology input is often needed if IV therapy is initiated, and the child can be referred to the Royal Eye Unit for assessment from the paediatric department. Ophthalmology are also contactable via Kinesis and aim to reply to queries within 24 hours – there is a facility to attach photographs as needed. If there is suspicion of a foreign body or traumatic eye injury, please refer directly to Eye Casualty at the Royal Eye Unit for their assessment. Rather than a walk-in facility, the Royal Eye Unit are now offering booked urgent appointments to facilitate social distancing in their waiting room – the dedicated phone number for this is 020 8934 6799.