From the Guidelines
Chloramphenicol eye drops are effective for treating bacterial conjunctivitis in children, but their use should be considered on a case-by-case basis due to the potential for mild bacterial conjunctivitis to be self-limiting. According to the most recent study 1, mild bacterial conjunctivitis is usually self-limited and resolves spontaneously without specific treatment in immune-competent adults, and the use of topical antibacterial therapy is associated with earlier clinical and microbiological remission.
Treatment Options
- Chloramphenicol eye drops can be used, typically dosed as 1-2 drops in the affected eye(s) every 2-6 hours for 5-7 days, with the frequency reduced as symptoms improve 1.
- Alternative treatments include fusidic acid eye drops, polymyxin B-trimethoprim drops, or erythromycin ointment.
- For viral conjunctivitis, supportive care with artificial tears and cold compresses is recommended, as it is self-limiting.
- Allergic conjunctivitis responds to antihistamine drops like ketotifen or olopatadine.
Important Considerations
- Many cases of conjunctivitis in children resolve spontaneously within 7-14 days without antibiotics 1.
- Good hygiene practices are essential during treatment, including handwashing, avoiding sharing towels, and cleaning discharge from eyes with clean cotton and warm water.
- If symptoms worsen or don't improve after 48 hours of treatment, medical reassessment is necessary.
- Indiscriminate use of topical antibiotics or corticosteroids should be avoided, as they can induce toxicity or prolong certain infections 1.
Prevention and Public Health
- The ophthalmologist plays a critical role in breaking the chain of transmission of epidemic adenoviral conjunctivitis by educating patients and families about proper hygiene 1.
- Infected individuals should be counseled to wash hands frequently, use a separate towel and pillow, and avoid close contact with others during the period of contagion.
From the Research
Effectiveness of Chloramphenicol Eye Drops in Children
- The effectiveness of chloramphenicol eye drops in children with infective conjunctivitis was studied in a randomised double-blind placebo-controlled trial 2.
- The study found that clinical cure by day 7 occurred in 128 (83%) of 155 children with placebo compared with 140 (86%) of 162 with chloramphenicol, with a risk difference of 3.8% (95% CI -4.1% to 11.8%).
- The study suggests that most children presenting with acute infective conjunctivitis in primary care will get better by themselves and do not need treatment with an antibiotic.
Alternative Treatments for Infective Conjunctivitis
- A study compared the effectiveness of ciprofloxacin and tobramycin in bacterial conjunctivitis in children, and found that both treatments were safe and effective, with similar microbiological eradication rates (90.1% for ciprofloxacin and 84.3% for tobramycin) 3.
- Another study compared fucidic acid to chloramphenicol eye drops in neonates with acute bacterial conjunctivitis, and found that fucidic acid was equally effective and easier to use than chloramphenicol 4.
- A review of several trials suggested that antibiotic therapy may not be needed for all cases of conjunctivitis in children, and that eye washing may be effective in some cases, with antibiotic eye drops only needed if symptoms persist 5.
- A study also compared a simplified dose regimen of chloramphenicol eye drops (four times a day) with a standard regimen (one drop hourly/every two hours for three days, thereafter every 4-6 hours), and found that the simplified regimen was preferable in clinical practice, with better compliance and similar clinical outcomes 6.