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Paediatric Treatment - Eye Infections

Conjunctivitis

First line: bathe/clean eyelids with cotton wool dipped in sterile saline or boiled (cooled) water, to remove crusting. [1D]
Treat only if severe, as most cases are viral or self-limiting.[2A+]

Bacterial conjunctivitis: usually unilateral and also self-limiting.[2A+, 3D] It is characterised by red eye with mucopurulent, not watery discharge.[3D] 65% and 74% resolve on placebo by days 5 and 7, respectively.[4A-,5A+].

Second line: fusidic acid as it has less gram-negative activity.[6A-,7D]

Medicine Calendar

First line: self-care

Second line: chloramphenicol 0.5% eye drop OR 1% ointment

EYE DROPS: 2 hourly for 2 days, then reduce frequency to 3-4 times daily EYE OINTMENT: 2 hourly for 2 days, then reduce frequency to 3-4 times daily OR just at night if using eye drops during the day.

48 hours after resolution

Third line: fusidic acid 1% gel

BD

48 hours after resolution

Blepharitis

First line: lid hygiene [1D,2A+] for symptom control [1D] including: warm compresses [1D,2A+], lid massage and scrubs [1D], gentle washing [1D], avoiding cosmetics [1D].

Second line: topical antibiotics if hygiene measures are ineffective after 2 weeks [1D,3A+].

Signs of Meibomian gland dysfunction or acne rosacea [3D]: consider oral antibiotics [1D]

Medicine Calendar

First line: self-care

Second line: chloramphenicol 1% eye ointment

BD

6 week trial

Third line: children 12 years and over, oral oxytetracycline OR oral doxycycline

Oxytetracyline 500mg BD for 4 weeks initially then 250mg BD for 8 weeks; OR doxycyline 100mg OD for 4 weeks then 50mg OD for 8 weeks

4 weeks initially, then 8 weeks maintenance

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).