Periorbital and orbital cellulitis - Emerging treatments

Delafloxacin

The Food and Drug Administration (FDA) and European Medicines Agency have approved delafloxacin, a fluoroquinolone antibacterial, for the treatment of acute bacterial skin and skin structure infections (ABSSSI) caused by designated susceptible bacteria. In a double blind phase II randomized clinical trial of patients with an ABSSSI, cure rates with delafloxacin were significantly greater than with vancomycin, and comparable to those of linezolid.[40] Specific application to periorbital/orbital cellulitis has yet to be described.

Omadacycline

Omadacycline is a tetracycline antibiotic with a broad-spectrum of activity. The FDA granted approval in 2018 for its use in the treatment of skin and soft tissue infections, including infection with staphylococcal and streptococcal species, and gram-negative bacteria.[41] Specific application to periorbital/orbital cellulitis has yet to be described.

Ceftaroline

Ceftaroline is a fifth-generation cephalosporin that has FDA approval for the treatment of skin and soft tissue infections caused by gram-positive organisms. Unlike other FDA-approved cephalosporins, it has activity against MRSA.[41] Specific application to periorbital/orbital cellulitis has yet to be described.

Dalbavancin

Dalbavancin is a second-generation glycopeptide antibiotic that has FDA approval for the treatment of skin and soft tissue infections. It provides coverage against gram-positive bacteria, including MRSA, and susceptible streptococcal isolates. Dalbavancin has a long plasma half-life conferring it the advantage of treatment with a single intravenous infusion.[41] In noninferiority trials, dalbavancin had similar efficacy to intravenous vancomycin followed by oral linezolid, in the treatment of ABSSSI.[42] Specific application to periorbital/orbital cellulitis has yet to be described.

Oritavancin

Oritavancin is a second-generation glycopeptide antibiotic that has FDA approval for the treatment of skin and soft tissue infections. It provides coverage against gram-positive bacteria, including MRSA, and susceptible streptococcal isolates. Like dalbavancin, oritavancin is administered as a single intravenous infusion. A 2014 randomized, double-blind trial, comparing oritavancin with vancomycin in the treatment of ABSSSI (including patients with MRSA infection), reported similar efficacy for both regimens.[43] Specific application to periorbital/orbital cellulitis has yet to be described.

Tedizolid

Tedizolid is an oxazolidine antibiotic, with FDA approval for the treatment of skin and soft tissue infections. It has activity against streptococcal and staphylococcal species, as well as vancomycin-resistant enterococci.[41] A meta-analysis of randomized-controlled trials comparing the efficacy of tedizolid with linezolid, in patients with ABSSSI, showed similar early response rates and risks of adverse events.[44] Specific application to periorbital/orbital cellulitis has yet to be described.

Iclaprim

The FDA has granted fast-track designation to iclaprim for the treatment of acute bacterial skin and skin structure infections.