From the Guidelines
The first line of treatment for pediatric conjunctivitis should be directed at the root cause, with topical antibiotics for bacterial cases, supportive care for viral cases, and antihistamine eye drops for allergic cases, as indicated by the most recent guidelines 1. The treatment approach depends on the cause of the conjunctivitis, which can be bacterial, viral, or allergic.
- For bacterial conjunctivitis, topical antibiotics such as erythromycin 0.5% ophthalmic ointment applied 3-4 times daily for 5-7 days are commonly recommended, as they effectively reduce the risk of complications and transmission 1.
- For viral conjunctivitis, which is self-limiting, supportive care with warm compresses and artificial tears is appropriate, as antibiotics are ineffective against viruses 1.
- Allergic conjunctivitis responds well to antihistamine eye drops like ketotifen 0.025% twice daily 1. Regardless of the cause, good hygiene practices are essential, including frequent handwashing, avoiding touching or rubbing the eyes, using separate towels and washcloths, and discarding eye makeup, to prevent the spread of infection, especially in bacterial cases which are highly contagious 1. It is also important to note that early detection and treatment can be both sight-saving and, in select cases, life-saving, particularly for conjunctivitis associated with systemic diseases or sexually transmitted infections 1. Therefore, treatment should begin promptly, and patients should be counseled on proper hygiene and referral to a specialist if necessary, to minimize the risk of transmission and ensure the best possible outcomes 1.
From the Research
First Line of Treatment for Pediatric Conjunctivitis
The first line of treatment for pediatric conjunctivitis depends on the cause of the condition.
- For bacterial conjunctivitis, topical antibiotic therapy is often used to shorten the duration of the disease and enhance eradication of the causative organism from the conjunctiva 2.
- For viral conjunctivitis, treatment is supportive, with options including artificial tears, cold compresses, and antihistamine eye drops 3.
- For allergic conjunctivitis, topical antihistamines with mast cell-stabilizing activity are the treatment of choice 4, 3.
Considerations for Treatment
When considering treatment for pediatric conjunctivitis, it is essential to take into account the potential risks and benefits of antibiotic use.
- Topical antibiotics may be beneficial in shortening the duration of bacterial conjunctivitis, but they may not be necessary in uncomplicated cases 5, 4.
- Systemic antibiotic therapy, such as oral cefixime, may not be more effective than topical therapy in eradicating conjunctival colonization with respiratory pathogens or preventing acute otitis media 6.
- Delayed antibiotic prescribing has been found to have similar symptom control as immediate prescribing, and strict personal hygiene is essential to decrease the risk of transmission 3.
Special Considerations
Certain cases of pediatric conjunctivitis may require special consideration, such as:
- Neonatal conjunctivitis, which requires unique care and consideration of potential pathogens 5.
- Conjunctivitis in contact lens wearers, which should always be treated for bacterial conjunctivitis and referred to evaluate for corneal ulcers 5.
- Conjunctivitis caused by sexually transmitted diseases, such as chlamydia and gonorrhea, which requires systemic treatment in addition to topical antibiotic therapy 4.