Bacterial conjunctivitis: Difference between revisions

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==Background==
==Background==
*Often due to staphylococcus or streptococcus
*Often due to [[staphylococcus]] or [[streptococcus]]


==Clinical Features==
==Clinical Features==
[[File:Bacterial conjunctivitis.jpg|thumb|]]
*Painless, unilateral or bilateral mucopurulent discharge
*Painless, unilateral or bilateral mucopurulent discharge
**Often causes adherence of the eyelids on awakening
**Often causes adherence of the eyelids on awakening
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{{Conjunctivitis DDX}}
{{Conjunctivitis DDX}}


==Diagnosis==
==Evaluation==
{{Clinical diagnosis of conjunctivitis}}
 
===Workup===
===Workup===
*Eye exam
*Eye exam
*Fluorescein stain of cornea (especially in infants) to assess for corneal lesion
*Fluorescein stain of cornea (especially in infants) to assess for corneal lesion
*Culture: if severe
*Culture: if severe
===Evaluation===
{{Clinical diagnosis of conjunctivitis}}


==Management==
==Management==
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<References/>
<References/>


[[Category:Ophtho]]
[[Category:Ophthalmology]]
[[Category:ID]]
[[Category:ID]]

Latest revision as of 15:39, 5 October 2019

Background

Clinical Features

Bacterial conjunctivitis.jpg
  • Painless, unilateral or bilateral mucopurulent discharge
    • Often causes adherence of the eyelids on awakening
  • Chemosis is common

Differential Diagnosis

Conjunctivitis Types

Evaluation

Workup

  • Eye exam
  • Fluorescein stain of cornea (especially in infants) to assess for corneal lesion
  • Culture: if severe

Evaluation

Clinical diagnosis of conjunctivitis

Conjunctivitis
Bacterial Viral Allergic
Bilateral 50% 25% Mostly
Discharge Mucopurulent Clear, Watery Cobblestoning, none
Redness Yes Yes Yes
Pruritis Rarely Rarely Yes
Additional Treatment: Antibiotics Treatment: Hygiene Seasonal

Management

Bacterial Conjunctivitis

  • Counsel patient/family on importance of hand hygiene/avoiding touching face to prevent spread!
  • Apply warm or cool compresses (for comfort and cleansing) every 4 hours, followed by instillation of ophthalmic antibiotic solutions

These options do not cover gonococcal or chlamydial infections

  • Polymyxin B/Trimethoprim (Polytrim) 2 drops every 6 hours for 7 days OR
  • Erythromycin applied to the conjunctiva q6hrs for 7 days OR
  • Levofloxacin 0.5% ophthalmic solution 1-2 drops every 2 hours for 2 days THEN every 6 hours for 5 days OR
  • Moxifloxacin 0.5% ophthalmic 1-2 drops every 2 hours for 2 days THEN every 6 hours for 5 days OR
  • Gatifloxacin 0.5% ophthalmic solution 1-2 drops every 2 hours for 2 days THEN 1 drop every 6 hours for 5 days OR
  • Azithromycin 1% ophthalmic solution 1 drop BID for 2 days THEN 1 drop daily for 5 days
  • Chloramphenicol 0.5% ophthalmic solution 1 drop QID for 7 days

NB: levofloxacin is preferred for contact lens wearers for coverage of pseudomonas. Advise not to wear contacts for duration of treatment

Chlamydial

  • Doxycycline 100mg PO BID for 7 days OR
  • Azithromycin 1g (20mg/kg) PO one time dose
  • Newborn Treatment: Azithromycin 20mg/kg PO once daily x 3 days or erythromycin PO 50 mg/kg/day in 4 divided doses for 14 days [1]
    • Disease manifests 5 days post-birth to 2 weeks (late onset)

Gonococcal

  • Due to increasing resistance, CDC recommends dual therapy with Ceftriaxone and Azithromycin (even if patient is negative for Chlamydia).
  • Ceftriaxone 250mg IM one dose PLUS
  • Azithromycin 1g PO one dose
  • Newborn Treatment:
    • Prophylaxis: Erythromycin ophthalmic 0.5% x1
    • Disease manifests 1st 5 days post delivery (early onset)
    • Treatment Ceftriaxone 25-50mg IV or IM, max 125mg or cefotaxime single dose of 100 mg/kg (preferred if the patient has hyperbilirubinemia)
    • Also requires evaluation for disseminated disease (meningitis, arthritis, etc.)

Disposition

  • Discharge with ophtho follow-up (if no improvement) in 3 - 4 days

See Also

References

  1. Zikic A, Schünemann H, Wi T, Lincetto O, Broutet N, Santesso N. Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-analysis. J Pediatric Infect Dis Soc. 2018 Aug 17;7(3):e107-e115. doi: 10.1093/jpids/piy060. PMID: 30007329; PMCID: PMC6097578.