What is the treatment for bacterial conjunctivitis in pediatric patients?

From the Guidelines

For pediatric patients with bacterial conjunctivitis, the treatment of choice is topical antibiotic eye drops or ointments, with erythromycin 0.5% ointment being a commonly prescribed option, applied to the affected eye(s) 2-3 times daily 1. When considering treatment options, it's essential to note that the cause of the conjunctivitis plays a significant role in determining the appropriate antibiotic therapy.

• For gonococcal conjunctivitis, ceftriaxone is the recommended treatment, with a dosage of 25–50 mg/kg body weight intravenous or IM, single dose, not to exceed 250 mg IM for children who weigh ≤45 kg 1.
• For chlamydial conjunctivitis, the treatment options vary based on the child's age and weight, with azithromycin being a commonly prescribed option for children ≥8 years, at a dosage of 1 g orally, single dose 1. Key considerations for treatment include:
• Ensuring the full prescribed course of treatment is completed, typically 5-7 days, even if symptoms improve earlier
• Cleaning discharge from the eyes with warm water and a clean cloth before applying medication
• Washing hands thoroughly before and after treatment
• Keeping the child's towels and washcloths separate from others to prevent spread
• Monitoring for improvement in symptoms, and reevaluating the child if symptoms worsen or don't improve after 48-72 hours of treatment 1.

From the FDA Drug Label

Bacterial Conjunctivitis: The recommended dosage regimen for the treatment of bacterial conjunctivitisis one or two drops instilled into the conjunctival sac(s) every two hours while awake for two days and one or two drops every four hours while awake for the next five days. In a randomized, double-masked, multicenter, parallel-group clinical trial of pediatric patients with bacterial conjunctivitis, between birth and 31 days of age, patients were dosed with Ciprofloxacin ophthalmic solution or another anti-infective agent. Clinical outcomes for the trial demonstrated a clinical cure rate of 80% at Day 9 and a microbiological eradication success rate of 85% at Day 9

The recommended treatment for bacterial conjunctivitis in pediatric patients is Ciprofloxacin ophthalmic solution. The dosage regimen is one or two drops instilled into the conjunctival sac every two hours while awake for two days, and then one or two drops every four hours while awake for the next five days. In pediatric patients between birth and 31 days of age, a clinical trial demonstrated a clinical cure rate of 80% and a microbiological eradication success rate of 85% at Day 9 2 2.

From the Research

Treatment for Bacterial Conjunctivitis in Pediatrics

• Bacterial conjunctivitis is a common pediatric problem, often presenting with purulent discharge and mattering of the eyelids 3.
• Treatment is supportive, with an individual approach to antibiotic use in uncomplicated cases, as it may shorten symptom duration but is not without risks 3.
• The use of topical antibiotics for bacterial conjunctivitis is supported, as it shortens the course of the disease, reduces discomfort, prevents person-to-person transmission, and reduces the rate of reinfection 4.
• A Cochrane review suggests that the use of antibiotic eye drops is associated with modestly improved rates of clinical and microbiological remission compared to the use of placebo 4.

Causes of Bacterial Conjunctivitis

• In the neonatal period, bacterial conjunctivitis is rare, and the most common cause of organism is Staphylococcus aureus, followed by Chlamydia trachomatis 4.
• In infants and older children, bacterial conjunctivitis is most often caused by Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis 4.
• Other rare causes of bacterial conjunctivitis include Neisseria gonorrhoeae 5 and Neisseria sicca 6.

Diagnosis and Management

• The diagnosis of bacterial conjunctivitis is made clinically, and cultures are unnecessary 4.
• Some authors suggest a watchful observation approach, as most cases of bacterial conjunctivitis are self-limited 4.
• Topical antibiotics are effective in treating bacterial conjunctivitis, but the choice of antibiotic may depend on the suspected or confirmed cause of the infection 4, 5, 6.