From the Research
Mupirocin is generally preferred over erythromycin for treating blepharitis in an 18-month-old child. Apply a small amount of mupirocin 2% ointment to the eyelid margins twice daily for 7-10 days. Use a clean cotton swab or fingertip to gently apply the ointment along the base of the eyelashes after cleaning the area with warm water. For cleaning, use a warm washcloth to gently wipe the eyelid margins to remove crusts before applying the medication. Mupirocin is favored because it provides excellent coverage against Staphylococcus aureus, which is a common cause of blepharitis in children, and typically has lower resistance rates compared to erythromycin. Additionally, mupirocin has better tissue penetration and remains active in the presence of inflammatory exudates. If mupirocin is unavailable, erythromycin 0.5% ointment can be used as an alternative with the same application schedule. Parents should be advised to wash their hands thoroughly before and after application and to expect some temporary blurring of vision after applying the ointment. If symptoms don't improve after 7 days of treatment or worsen at any point, the child should be reevaluated.
The most recent and highest quality study, 1, suggests that oral antibiotics may improve clinical signs, but may cause more adverse events, however, this study is focused on chronic blepharitis and oral antibiotics, which is not directly applicable to the treatment of blepharitis in an 18-month-old child with topical antibiotics. Another study, 2, found that topical antibiotics were shown to provide some symptomatic relief and were effective in eradicating bacteria from the eyelid margin for anterior blepharitis, which supports the use of mupirocin.
Some key points to consider when treating blepharitis in children include:
- Cleaning the eyelid margins with a warm washcloth to remove crusts before applying the medication
- Using a clean cotton swab or fingertip to gently apply the ointment along the base of the eyelashes
- Advising parents to wash their hands thoroughly before and after application
- Expecting some temporary blurring of vision after applying the ointment
- Reevaluating the child if symptoms don't improve after 7 days of treatment or worsen at any point.
It's also important to note that the evidence for the treatment of blepharitis is not strong, and further research is needed to evaluate the effectiveness of different treatments, as stated in 2. However, based on the available evidence, mupirocin is generally preferred over erythromycin for treating blepharitis in an 18-month-old child.