Treatment of Conjunctivitis in Babies
For bacterial conjunctivitis in babies, a 5-7 day course of broad-spectrum topical antibiotic applied 4 times daily is the recommended first-line treatment. 1, 2
Diagnosis and Treatment Algorithm
Mild Bacterial Conjunctivitis
- Apply broad-spectrum topical antibiotic ointment (approximately 1 cm in length) directly to the infected eye(s) up to six times daily, depending on severity 1, 3
- Treatment should continue for 5-7 days until clinical improvement is noted 1, 2
- The choice of antibiotic is usually empiric, with no evidence suggesting superiority of any particular antibiotic 1
- In areas with limited access to antibiotics, povidone-iodine 1.25% ophthalmic solution may be considered as an alternative 1, 2
Moderate to Severe Bacterial Conjunctivitis
- Characterized by copious purulent discharge, pain, and marked inflammation 1
- Obtain conjunctival cultures and Gram staining if gonococcal infection is suspected 1
- Antibiotic choice should be guided by laboratory test results 1
- For severe cases, consider referral to an ophthalmologist 2, 4
Special Considerations for Specific Infections
Gonococcal Conjunctivitis
- Requires systemic antibiotic therapy in addition to topical treatment 1, 2
- Saline lavage may promote comfort and more rapid resolution of inflammation 1
- Daily follow-up until resolution is necessary 1, 2
- For infants born to mothers with clinically apparent gonorrhea, intravenous or intramuscular injections of aqueous crystalline penicillin G should be given 3
Chlamydial Conjunctivitis
- Systemic antibiotic therapy is indicated as more than 50% of infants may have infection at other sites (nasopharynx, genital tract, lungs) 1, 2
- Empiric antibiotic therapy can be considered for symptoms highly suggestive of chlamydia 1
- Re-evaluation following treatment is important due to potential treatment failure (up to 19%) 1
- Erythromycin ophthalmic ointment has shown effectiveness in preventing chlamydial conjunctivitis in newborns 5
Supportive Measures
- Strict hand hygiene to prevent transmission to others or to the unaffected eye 2, 4
- Avoid sharing towels or close contact during the period of contagion 2, 4
- Patients can generally return to daycare once treatment has been initiated for 24 hours and symptoms begin to improve 4
When to Refer to an Ophthalmologist
- Visual loss, moderate or severe pain, severe purulent discharge 2, 4
- Corneal involvement or conjunctival scarring 2
- Lack of response to therapy after 3-4 days 1, 2, 4
- Recurrent episodes 2
- History of HSV eye disease or immunocompromise 2
Common Pitfalls to Avoid
- Indiscriminate use of topical antibiotics or corticosteroids 2
- Failure to consider gonococcal or chlamydial infection in infants, which requires systemic treatment 2
- Not considering the possibility of child abuse in cases of potentially sexually transmitted ocular disease 1, 2
- Delayed referral when there are signs of severe infection or lack of improvement 2
Evidence on Treatment Efficacy
- Topical antibiotic therapy shortens the duration of clinical disease and enhances eradication of causative organisms 6
- Without treatment, approximately 50% of patients recover within four days, but antibiotic therapy hastens recovery 7, 8
- Most common pathogens in pediatric bacterial conjunctivitis are Haemophilus influenzae and Streptococcus pneumoniae 9