Immediate IV steroid use for children with orbital cellulitis shortens length of hospital stay

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The use of IV steroids in combination with antibiotics on admission for children with orbital cellulitis led to faster clinical improvements and reduced hospital stays, according to a study.

The use of steroids in acute orbital infections is considered controversial and is not the current standard of care, said Charlotte Marous, MD, during a presentation at the 2020 ASOPRS Virtual Meeting.

Questions regarding steroid use in infections include whether they mask significant residual disease and allow progression of the infection by immunosuppression.

A 2018 study which compared outcomes in children with orbital cellulitis given IV steroids in combination with antibiotic on admission versus antibiotics alone, found immediate steroids to be safe and beneficial.

In a new prospective, single-center, comparative interventional study, all children (n = 60) admitted with orbital cellulitis were started on broad-spectrum IV antibiotics and IV dexamethasone on admission. The control patients (n = 15) from the 2018 study severed as a comparison group.

Patients were discharged after transition to PO antibiotics after 24 hours with clinical improvement and followed in the outpatient setting until achieving baseline health.

“The original findings held true here. Patients who receive IV steroids and antibiotics on admission had significantly shorter hospital stays compared to patients who did not receive steroids at the time of admission.”

Patients receiving combination therapy had an average hospital stay of 3.4 days compared with 6.7 days in patients receiving antibiotics alone. In addition, IV steroid use did not lead to the progression of disease or an increased likelihood of undergoing surgery.


Marous C, et al. Intravenous Steroids on Admission for Children with Orbital Cellulitis – 9-year experience. Presented at 2020 ASOPRS Virtual Meeting.

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