From the Guidelines
Topical erythromycin (EMycin) ointment is recommended for the treatment of blepharitis in children, applied to the eyelid margins one or more times daily or at bedtime for a few weeks, as it has been shown to provide symptomatic relief and decrease bacteria from the eyelid margin in cases of anterior blepharitis 1. When using topical erythromycin for blepharitis in kids, it's essential to follow proper application and hygiene techniques to ensure effectiveness and minimize potential side effects.
- A small amount (approximately 1/4 inch or the size of a grain of rice) should be applied using a clean fingertip or cotton swab, gently spreading it along the base of the eyelashes after cleaning the eyelids.
- Before application, warm compresses should be applied to the closed eyelids for 5-10 minutes, followed by gentle lid scrubs using diluted baby shampoo or commercial eyelid cleansers to remove crusts and debris.
- Parents should ensure their child washes hands before and after application and should be advised that temporary blurring of vision may occur after application. The treatment should be guided by the severity of the blepharitis and response to treatment, with the option to repeat the treatment on an intermittent basis using different kinds of medications with different mechanisms of action to prevent the development of resistant organisms 1. It's also important to note that oral erythromycin or azithromycin may be used as an alternative to tetracyclines in children, with a suggested dosing regimen for erythromycin in children being 30 to 40 mg/kg divided over 3 doses for 3 weeks, then twice daily for 4 to 6 weeks 1. However, due to the lack of high-quality evidence, more clinical trials are necessary to establish safety and efficacy for the proper treatment of blepharokeratoconjunctivitis in children 1.
From the FDA Drug Label
PRECAUTIONS: General: For topical use only; not for ophthalmic use. Information for Patients: ...Avoid contact with the eyes, nose, mouth, and all mucous membranes Pediatric Use: Safety and effectiveness of this product in pediatric patients have not been established.
The use of topical erythromycin for blepharitis in children is not recommended because the drug label states that it is not for ophthalmic use and that safety and effectiveness in pediatric patients have not been established 2.
From the Research
Topical Erythromycin for Blepharitis in Kids
- There is limited research on the use of topical erythromycin for blepharitis in children, with most studies focusing on oral erythromycin treatment 3, 4, 5.
- However, oral erythromycin has been shown to be effective in treating blepharokeratoconjunctivitis in children, with studies demonstrating significant improvement in clinical symptoms and signs 3, 4, 5.
- One study found that oral erythromycin therapy had a steroid-sparing effect, allowing for the reduction of topical steroid use in children with blepharokeratoconjunctivitis 5.
- Another study found that long-term, low-dose oral azithromycin treatment was effective in treating chronic severe bilateral blepharokeratoconjunctivitis in pediatric patients, but did not specifically address topical erythromycin use 6.
- Erythromycin has been shown to be a valuable and useful antimicrobial agent in children, with a low index of toxicity and reliable absorption when administered orally 7.
Treatment Considerations
- The use of topical antibiotics, including erythromycin, may be considered as part of a comprehensive treatment plan for blepharitis in children, but more research is needed to determine its efficacy and safety in this population.
- Lid hygiene and topical steroids are also commonly used in the treatment of blepharitis in children, and may be used in conjunction with oral or topical antibiotics 4, 5.
- The choice of treatment should be individualized based on the severity of the condition, the presence of any underlying medical conditions, and the patient's response to previous treatments.