Douglas J. Rhee, MD

244. Recent studies suggest that anaerobic bacteria may play a larger role in orbital cellultitis than previously thought. Considerationshould be given to adding intravenous metronidazole (Flagyl; 7.5 mg/kg three times daily, max dose 400 mg), especially ifthe clinical exam does not improve with standard antibiotic therapy.5. If no improvement, suspect abscess or resistant organism.(11) Prophylaxis of Posttraumatic Endophthalmitis Following Open Globe Injuries (including full thickness corneal laceration)Notes: 1. On presentation place an eye shield without contact to globe and keep patient NPO.2. Treatment is prompt surgical exploration and repair.3. Admit and give systemic antibiotics for 36 hours—give two (i.e., vancomycin plus ceftazidime or vancomycin pluslevofloxacin):Drug Trade Dose Notesvancomycin Vancocin 1 gm IV Q12 hr Adult dose 240 mg/kg/day IV in 2–4 divided doses Pediatric dose 215 mg/kg load, maintenance dose 10 mg/kg Neonatal dose 2BID-TIDPLUSceftazidime Fortaz 1 gm IV Q8 hr Adult dose25–50 mg/kg IV Q8 hr (max 6 g/day) Pediatric doseORlevofloxacin Levaquin 500 mg IV or po Q24 hr Not approved for use in childrenModify dose in renal failure