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In Reply.—Dr Gutman has made an important point. Because of the possible complications of untreated or inadequately treated orbital cellulitis (including cavernous sinus thrombosis, meningitis, and brain abscess), it is important that appropriate antibiotics be chosen and used promptly in high dosages. Since the time of submission of our manuscipt, strains of ampicillin-resistant H influenzae type b have appeared in Pittsburgh and in many other areas. A new recommendation from the Committee on Infectious Diseases of the American Academy of Pediatrics has been published (Pediatrics 57:417, 1976), which again emphasizes the importance of initial treatment with a parenteral penicillin and intravenous chloramphenicol for suspected or proved severe disease due to H influenzae type b, but, perhaps inadvertently, it does not mention cellulitis, not even orbital cellulitis.
Orbital cellulitis should be included in this recommendation if the patient is less than 5 years old, and particularly if the patient is
Michaels RH, Hiles DA. Human Tear pH-Reply. Arch Ophthalmol. 1977;95(1):170. doi:10.1001/archopht.1977.04450010170032