What is the most appropriate initial treatment for orbital cellulitis?

The most appropriate initial treatment for orbital cellulitis is inpatient intravenous (IV) antibiotics. Orbital cellulitis is a serious infection that involves the tissues surrounding the eye and poses a risk of complications, such as vision loss or the spread of infection to the brain. Given the potential severity of this condition, it is imperative to initiate treatment promptly and with sufficient potency.

IV antibiotics provide immediate systemic coverage against the likely pathogens, which often include Streptococcus pneumoniae and Staphylococcus aureus, among others. The choice of IV antibiotics is typically tailored based on local resistance patterns and the patient's presentation, but broad-spectrum coverage is essential in the initial management phase.

Outpatient oral antibiotics would not be sufficient due to the need for aggressive treatment in suspected cases of orbital cellulitis, especially when significant symptoms or complications arise. Topical antibiotics are also not effective since the infection is deeper in the orbital tissues and cannot be adequately addressed through topical treatments. Observation only would pose a significant risk as this condition can deteriorate rapidly, necessitating immediate intervention. Therefore, inpatient IV antibiotics are critical for the effective management of orbital cellulitis and preventing serious complications.