Fusidic Acid (Fucithalmic) Dosing for Bacterial Conjunctivitis in Children Under 5
For bacterial conjunctivitis in children under 5 years, fusidic acid viscous eye drops should be administered as 1 drop twice daily for 7 days. 1, 2
Dosing Regimen
- Apply 1 drop of fusidic acid 1% viscous drops (Fucithalmic) to the affected eye(s) twice daily for 7 days 1, 2
- This twice-daily regimen has demonstrated equivalent clinical and bacteriological efficacy compared to more frequent dosing schedules with other antibiotics 1, 2
Evidence Supporting This Regimen
- A randomized trial in 456 neonates demonstrated that fusidic acid 1% applied twice daily achieved an 89% cure rate, comparable to chloramphenicol 0.5% applied six times daily (87.9%) 1
- Compliance was significantly superior with twice-daily fusidic acid (90.7%) compared to six-times-daily chloramphenicol (78.0%) in the neonatal population 1
- In children aged 2-9 years with bacterial conjunctivitis, compliance with fusidic acid twice daily was 85% versus only 47% with tobramycin four to six times daily (p < 0.001) 2
Clinical Efficacy Timeline
- Clinical improvement typically begins within 3-5 days of treatment initiation 2, 3
- Complete the full 7-day course even if symptoms improve earlier to ensure bacteriological eradication 1, 2
- Bacteriological recovery is frequently achieved by day 3-5 of treatment 4
Important Clinical Considerations
- If no improvement is noted after 3-4 days, consider alternative diagnoses, resistant organisms, or referral to ophthalmology 5, 6
- The viscous formulation of fusidic acid provides prolonged contact time with the ocular surface, contributing to efficacy with less frequent dosing 2
- Parents rated fusidic acid as significantly more convenient than more frequently dosed alternatives (97% vs. 54% in children aged 2-9 years) 2
Common Pitfalls
- Do not confuse fusidic acid dosing with fluoroquinolone dosing regimens, which require more frequent administration (every 2-4 hours initially) 7
- Ensure parents understand that "twice daily" means approximately every 12 hours, not just morning and evening at variable times 1
- Avoid touching the dropper tip to any surface to prevent contamination 8