Subperiosteal abscess of the orbit: duration of intravenous antibiotic therapy in nonsurgical cases.

PURPOSE

To report the duration of intravenous (IV) antibiotic administration and outcomes in a cohort of patients with subperiosteal abscess (SPA) of the orbit triaged to nonsurgical management.

METHODS

A retrospective cohort study based on records of patients younger than 9 years admitted to a regional pediatric hospital with a diagnosis of orbital cellulitis from 1999 through 2008. Patients with computed tomography (CT)-confirmed SPA and associated sinusitis were included. Patients who underwent surgical drainage of sinuses and/or orbits during that admission were excluded. Patients discharged with a peripherally inserted central catheter for a predetermined treatment interval were excluded. Dates and times of first and last doses of inpatient IV antibiotics were recorded. Records were reviewed for evidence of hospital readmission for relevant diagnoses. Outcome measures included duration of IV antibiotic administration and hospital readmission.

RESULTS

Forty-two patients met study criteria. Duration of IV treatment ranged from 2 to 8 days (mean and median, each 4 days). Forty-one patients were not readmitted with a relevant diagnosis from the time of hospital discharge to completion of data acquisition in April 2011. One patient was readmitted for recurrent acute infection 10 weeks after discharge and underwent urgent SPA and sinus drainage; review of the initial CT revealed an ethmoidal mucocoele.

CONCLUSIONS

The duration of IV therapy associated with successful nonsurgical management of appropriately selected children with SPA is considerably shorter than that recommended in current pediatric infectious disease literature. The findings suggest that clinical judgment, based on each patient's initial CT findings and evolving signs, symptoms, and laboratory profile, should be a major determinant of IV intervals.