Adjunctive systemic corticosteroids in pediatric orbital cellulitis: a systematic review and meta-analysis

Orbital cellulitis is a serious pediatric infection that can cause vision- and life-threatening complications. Adjunctive systemic corticosteroids are sometimes added to antibiotics to reduce inflammation, but their effectiveness and safety in children remain uncertain.

We conducted a PRISMA-compliant systematic review and meta-analysis of studies evaluating adjunctive systemic corticosteroids in children (<21 years) hospitalized with orbital cellulitis. Eligible studies compared corticosteroid plus antibiotics vs. antibiotics alone and reported hospital length of stay (LOS), surgical intervention, pediatric intensive care unit (PICU) admission, or 30-day readmission. Randomized and observational studies were included. Data were pooled using random- or fixed-effects models depending on heterogeneity.

Six studies (n = 11,803; 1,811 corticosteroid, 9,992 control) met inclusion criteria. Corticosteroid use was not associated with a statistically or clinically meaningful reduction in LOS (mean difference -0.43 days, 95% CI: -2.34 to 1.49). Corticosteroid use was associated with higher risks of surgery (RR 2.08, 95% CI: 1.47-2.96), PICU admission (RR 1.82, 95% CI: 1.36-2.45), and 30-day readmission (RR 2.53, 95% CI: 1.94-3.29). Certainty of evidence was low to moderate, largely due to observational data.

Adjunctive corticosteroids were not associated with shorter hospitalization and may be associated with increased risks of adverse outcomes. These findings should be interpreted with caution given the observational nature of most included studies and potential confounding. High-quality pediatric randomized controlled trials are needed to better define the role of corticosteroids in orbital cellulitis.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251102999, PROSPERO CRD420251102999.