› Adjunctive measures
› Analgesia strategy
› Acetaminophen dosing per weight
› Opioid sparing options
› Eye surface protection
› Lubricating ointment if exposure
› Moisture chamber if incomplete lid closure
› Glycemic control
› Hyperglycemia management in diabetics
› DKA screening if symptomatic
› Adult empiric regimens
› First-line broad coverage
› Ampicillin-sulbactam IV 3 g every 6 hours
› Spectrum includes streptococci
› Spectrum includes MSSA
› Spectrum includes anaerobes
› If MRSA risk add vancomycin IV 15 to 20 mg/kg every 8 to 12 hours
› Target trough per local protocol
› Renal dosing adjustment
› Alternative broad coverage
› Ceftriaxone IV 2 g every 24 hours
› Add metronidazole IV 500 mg every 8 hours for anaerobes
› Add vancomycin IV 15 to 20 mg/kg every 8 to 12 hours for MRSA risk
› Severe infection or intracranial extension concern
› Piperacillin-tazobactam IV 4.5 g every 6 hours
› Add vancomycin IV 15 to 20 mg/kg every 8 to 12 hours
› Broader gram negative coverage
Pediatric empiric IV antibiotics
› Pediatric empiric regimens
› Weight-based broad coverage
› Ampicillin-sulbactam IV 50 mg/kg per dose as ampicillin every 6 hours
› Maximum 2 g ampicillin per dose
› Sinusitis source coverage
› If MRSA risk add vancomycin IV 15 mg/kg per dose every 6 hours
› Target trough per local protocol
› Renal dosing adjustment
› Beta lactam allergy strategy
› Clindamycin IV 10 mg/kg per dose every 8 hours
› Maximum 900 mg per dose
› MRSA and anaerobe coverage
› Add ceftriaxone alternative only if non-anaphylactic allergy
› Ceftriaxone IV 50 mg/kg every 24 hours
› Maximum 2 g daily
Antifungal and atypical coverage
› Expanded coverage triggers
› Suspected mucormycosis
› DKA
› Immunosuppression
› Amphotericin B initiation in high suspicion cases
› Liposomal amphotericin dosing per specialist protocol
› Immediate ENT and ophthalmology co-management
› Odontogenic source expansion
› Anaerobe coverage ensured
› Dental or OMFS involvement
› Anti-inflammatory adjuncts
› Systemic corticosteroids
› Consider only after antibiotics started
› Specialist-guided timing
› Nasal therapies for sinus source
› Saline irrigation
› Intranasal corticosteroid per ENT plan
› Drainage pathways
› Endoscopic sinus surgery indications
› Abscess on imaging
› Failure to improve within 24 to 48 hours
› Orbit decompression or drainage indications
› Vision compromise
› Orbital abscess
› Evidence framing
› Class I recommendation for surgical drainage when vision threatened
› Class IIa recommendation for drainage in failure of medical therapy
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