Treatment of Pediatric Conjunctivitis (Pink Eye)
Topical antibiotics are recommended for bacterial conjunctivitis in children as they reduce symptom duration, improve clinical outcomes, and allow earlier return to school. 1, 2
Treatment Algorithm Based on Suspected Etiology
Bacterial Conjunctivitis
- First-line treatment: Topical fluoroquinolone antibiotics (levofloxacin, moxifloxacin, gatifloxacin, ciprofloxacin, or besifloxacin) administered 4 times daily for 5-7 days for children older than 12 months 1
- Alternative options include erythromycin ophthalmic ointment applied directly to the infected eye(s) up to six times daily, depending on severity 3
- Bacitracin ointment can be applied directly into the conjunctival sac 1 to 3 times daily 4
- Polymyxin B/trimethoprim is another effective option for bacterial conjunctivitis 2
- Treatment accelerates clinical and microbiological remission, with studies showing 62% of treated patients cured by 3-5 days versus only 28% of untreated patients 5
Gonococcal Conjunctivitis
- Requires systemic antibiotic therapy in addition to topical treatment 6, 2
- For children weighing <45 kg: Ceftriaxone 125 mg IM, single dose 6
- For children weighing ≥45 kg: Same treatment as adults (Ceftriaxone 250 mg IM, single dose) 6
- Daily follow-up until resolution is recommended 7
Chlamydial Conjunctivitis
- Requires systemic antibiotic therapy rather than topical treatment alone 2
- For children weighing <45 kg: Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into four doses daily for 14 days 6
- For children ≥8 years: Azithromycin 1 g orally, single dose or Doxycycline 100 mg orally, twice daily for 7 days 6, 7
Special Considerations
Severity-Based Approach
- For mild cases: Consider a "wait and see" approach for 2-3 days with eye washing before starting antibiotics, as about 50% of patients recover within four days without antibiotic therapy 8
- For moderate to severe cases: Obtain conjunctival cultures before starting treatment if severe purulent discharge is present 1, 2
- Refer to an ophthalmologist if there is visual loss, severe pain, severe purulent discharge, corneal involvement, or lack of response to therapy 1, 2, 7
Neonatal Conjunctivitis
- Requires special attention due to unique pathogens and considerations 9
- For ophthalmia neonatorum due to N. gonorrhoeae: Ceftriaxone 25–50 mg/kg IV or IM, single dose, not to exceed 125 mg 6
- For ophthalmia neonatorum due to C. trachomatis: Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into four doses daily for 14 days 6
Patient Education and Prevention
- Hand washing is crucial to reduce the risk of transmission 1, 7
- Avoid sharing towels and close contact with others during the contagious period 1, 7
- Children can generally return to school once treatment has been initiated for 24 hours and symptoms begin to improve 1, 7
Follow-Up Recommendations
- Return for evaluation if no improvement is seen after 3-4 days of treatment 1, 2, 7
- Consider alternative diagnoses or resistant organisms if symptoms persist despite appropriate treatment 1, 7