Conjunctivitis (peds)
Background
Differential Diagnosis
- Viral
- Most frequently caused by adenovirus
- Herpes infection requires immediate treatment
- Bacterial
- Consider chlamydial and gonococcal, esp in adolescents
- Allergic
- Kawasaki Disease
- Pediculosis
Treatment
Bacterial Causes
Newborn
- Azithromycin 20mg/kg PO once daily for 3 days OR
- Erythromycin 12.5 mg/kg PO q6hrs for 14 days
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.)
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
Viral Causes
- Non-herpetic: supportive care
- Herpetic: Acyclovir, ophto referral
Allergic
- Artificial tears and avoidance of allergens
- Consider topical anti-histamines for severe symptoms
Anti-Histamines
- Ketotifen 1 drop q8-12hr OR
- Olopatadine 1-2 drop daily
See Also
Source
Tintinalli
- ↑ 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.