11/27/2024

Kids Corner - Prescribing Antibiotics for Children

Kids Corner - Prescribing Antibiotics for Children

With the new school year underway, you may find an uptick in the number of young patients you see with infectious conjunctivitis. 

Bacterial conjunctivitis in the pediatric population is far more common than it is in the adult population.¹ A 2022 study by Johnson, Lui and Simel found that as many as 70% of cases of conjunctivitis in children are due to bacterial infection while only 16% of cases of conjunctivitis were found to be bacterial in nature for adults.  Viral conjunctivitis is also very common with adenoviruses being the leading cause. 

Fortunately, most cases of bacterial conjunctivitis are self-limiting…they will resolve without treatment typically within about 10 days.²  A recent study in Finland found that treatment with an antibiotic eye drop was only slightly more effective than using artificial tears alone in shortening the time to symptom resolution to about 4 days.³  This means that in some instances, supportive treatment with artificial tears may be all that is needed. 

If the clinical presentation leads to the decision to prescribe an antibiotic eye drop, there are many broad-spectrum choices that are safe and effective for children (see the table below). Providing reassurance and demonstrating how to instill the eye drop can go a long way in helping both the child and the parent feel more at ease.  

In the rare instance that the clinical presentation leads to the decision to prescribe an oral antibiotic for the child, a very judicious evaluation of the child’s age, weight and the pharmacology of the antibiotic is critical to avoid adverse drug reactions and dosing errors. Ocular conditions that may necessitate prescribing an oral antibiotic include cases of preseptal cellulitis or dacryocystitis. 

And finally, serious infections are always a possibility. Contact lens wearing patients, in particular, are at a greater risk for a rapidly developing infection due to pseudomonas aeruginosa and may not be responsive to initial topical treatment. Bacteria that are resistant to treatment, such as methicillin resistant Staphylococcus aureus (MRSA) can be a concern. Ocular surface toxicity to topical antibiotics is fairly common also.⁴ Therefore, always follow children closely to ensure their condition resolves as expected. 

1.  Johnson D., Lui D., Simel D. Does This Patient With Acute infectious Conjunctivitis Have a Bacterial Infection?: The Rational Clinical Examination Systematic Review.  JAMA 2022, 327,2231. 
   
   
2. Mahoney MJ., Bekibele R., Notermann SL., Reuter TG., Borman-Shoap EC. Pediatric Conjunctivitis: A Review of Clinical Manifestations, Diagnosis, and Management. Children 2023, 10,808 
   
   
3. Honkila M., Koskela U., Kontiokari T., Mattila ML, Kristo A., Valtonen R., Sarlin S., Paalanne N., Ikaheimo L, Pokka T., et al. Effect of Topical Antibiotics on Duration of Acute Infective Conjunctivitis in Children: A Randomized Clinical Trial and a Systematic Review and Meta-Analysis. JAMA Network Open, 2022 Oct; 5(10):e2234459 
   
   
4. Stern GA, Killingsworth DW. Complications of topical antimicrobial agents.  Int Ophthalmol Clin 1989;29:137-142