Treatment of Pediatric Conjunctivitis (Pink Eye)
For pediatric patients with bacterial conjunctivitis, a 5-7 day course of broad-spectrum topical antibiotic applied 4 times daily is the recommended first-line treatment. 1
Treatment Algorithm Based on Type and Severity
Bacterial Conjunctivitis (Most Common in Children)
- Apply topical antibiotic ointment or drops 4 times daily for 5-7 days 1, 2
- FDA-approved topical antibiotics for children include fluoroquinolones (levofloxacin, moxifloxacin, gatifloxacin, ciprofloxacin, besifloxacin) for children older than 12 months 1
- Erythromycin ophthalmic ointment is approved for pediatric use and should be applied directly to the infected eye(s) up to six times daily, depending on severity 3
- Topical antibiotics shorten the course of disease, reduce discomfort, and prevent person-to-person transmission 4
Moderate to Severe Bacterial Conjunctivitis
- Consider obtaining conjunctival cultures before starting treatment if severe purulent discharge is present 1, 2
- For severe cases with vision loss, severe pain, or corneal involvement, refer to an ophthalmologist 1, 5
- Methicillin-resistant S. aureus (MRSA) is an increasing concern and may require alternative antibiotics 1, 2
Special Considerations for Specific Infections
- For gonococcal conjunctivitis: systemic antibiotic therapy is necessary in addition to topical treatment with daily follow-up until resolution 6, 5
- For chlamydial conjunctivitis: systemic antibiotic therapy is indicated, especially in infants, as more than 50% may have infection at other sites 6, 5
- Sexual abuse should be considered in children with gonococcal or chlamydial infections 6, 5
Clinical Features Suggesting Bacterial Conjunctivitis
- History of gluey or sticky eyelids combined with physical finding of mucoid or purulent discharge has a 96% probability of bacterial infection 7
- Bacterial conjunctivitis is more common in children and typically presents with mucopurulent discharge with eyelids matted shut 8
- Most common bacterial pathogens in children are Haemophilus influenzae (82%), Streptococcus pneumoniae (16%), and Staphylococcus aureus (2.2%) 7
Follow-Up Recommendations
- Advise parents to return with the child for evaluation in 3-4 days if no improvement is noted 1, 2
- If no improvement after 3-4 days of treatment, consider alternative diagnoses or resistant organisms 1, 5
- For gonococcal conjunctivitis, daily follow-up is required until resolution 6, 2
Prevention of Transmission
- Hand washing is crucial to reduce the risk of transmission 1, 5
- Avoid sharing towels and close contact with others during the contagious period 1, 2
- Children can generally return to school once treatment has been initiated for 24 hours and symptoms begin to improve 1
When to Refer to an Ophthalmologist
- Immediate referral is recommended for patients with visual loss, moderate or severe pain, severe purulent discharge, corneal involvement, or lack of response to therapy after 3-4 days 1, 5
- Contact lens wearers with conjunctivitis should always be referred due to higher risk of complications 2, 8
- Neonatal conjunctivitis requires special care with unique pathogens and considerations 5, 9
Common Pitfalls to Avoid
- Indiscriminate use of topical antibiotics or corticosteroids should be avoided 5
- Failure to consider gonococcal or chlamydial infection in infants, which requires systemic treatment 5
- Not considering the possibility of child abuse in cases of potentially sexually transmitted ocular disease in children 5, 2