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Conjunctivitis (peds)
From WikEM
Contents
Background
Differential Diagnosis
- Viral
- Most frequently caused by adenovirus
- Herpes infection requires immediate treatment
- Measles
- Bacterial
- Consider chlamydial and gonococcal, especially in adolescents
- Allergic
- Kawasaki Disease
- Pediculosis
Management
Bacterial Causes
Newborn
- Azithromycin 20mg/kg PO once daily for 3 days OR
- Erythromycin 12.5 mg/kg PO q6hrs for 14 days
Chlamydial
- Doxycycline 100mg BID for 7 days OR
- Azithromycin 1g (20mg/kg) PO one time dose
- Newborn Treatment: Azithromycin 20mg/kg PO once daily x 3 days
- Disease manifests 5 days post-birth to 2 weeks (late onset)
Gonococcal
- Dual treatment for Chlamydia is recommended with azithromycin
- Ceftriaxone 1g IM one dose PLUS
- Azithromycin 1g PO one dose
- Newborn Treatment:
- Prophylaxis: Erythromycin ophthalmic 0.5% x1
- Disease manifests 1st 5 days post delivery (early onset)
- Treatment Ceftriaxone 25-50mg IV or IM, max 125mg
Bacterial Conjunctivitis
These options do not cover gonococcal or chlamydial infections
- Polymyxin B/Trimethoprim (Polytrim) 2 drops every 6 hours for 7 days OR
- Erythromycin applied to the conjunctiva q6hrs fir 7 days OR
- Levofloxacin 0.5% ophthalmic solution 1-2 drops every 2 hours for 2 days THEN every 6 hours for 5 days OR
- Moxifloxacin 0.5% ophthalmic 1-2 drops every 2 hours for 2 days THEN every 6 hours for 5 days OR
- Gatifloxacin 0.5% ophthalmic solution 1-2 drops every 2 hours for 2 days THEN 1 drop every 6 hours for 5 days OR
- Azithromycin 1% ophthalmic solution 1 drop BID for 2 days THEN 1 drop daily for 5 days
Viral Causes
- Non-herpetic: supportive care
- Herpetic: Acyclovir, ophto referral
Allergic
- Artificial tears and avoidance of allergens
- Consider topical anti-histamines for severe symptoms
Anti-Histamines
- Ketotifen 1 drop q8-12hr OR
- Olopatadine 1-2 drop daily
