Conjunctivitis (peds)

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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

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

See Also

References