How do you determine the duration and taper of systemic corticosteroids when you add them alongside antibiotics for orbital cellulitis?
2 Answers
Mednet MemberInvited Expert
Ophthalmology · Harvard Medical School
Answered on
There is no 'standard of care' answer for this. My personal preference is the following:
- Pediatric patients -- 0.25 to 0.5 mg/kg dexamethasone daily (given in AM) for up to 3 days, starting the day after source control/cultures from surgery. Higher dose/longer duration if very inflamed, and lower dose/consider only 1-2 days if less inflamed or generally healing quickly. If you prefer to give throughout the day, you could do 0.1-0.3 mg/kg q 6-8 hours for up to 3 days.
- Adult patients -- 40-80 mg IV Solumedrol daily for up to 3 days, followed by oral prednisone taper over a week. Same as for kids, generally the lower end of this dosing unless very inflamed, and starting AFTER surgical source control/cultures.
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Mednet Member
Ophthalmology · Advanced Eye Centers Inc
Answered on
I am not sure why this obsession with giving 'steroids' in the context of a bacterial infection? When you look at the logic, I am not convinced there is any. If I have a bacterial infection on my finger or wherever, I do not prescribe, and I would not take prednisone or dexamethasone, so why use steroids here? Seems like a bad idea.
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