Sandbox-ID-Yaz

Conjunctivitis

• Conjunctivitis, infectious

• Infectious conjunctivitis

• 1. Causative pathogens

• Neisseria gonorrhoeae
• Chlamydia trachomatis
• Staphylococcus aureus
• Staphylococcus epidermidis
• Streptococcus pneumoniae
• Streptococcus haemolyticus
• Haemophilus influenzae
• Moraxella spp.
• Proteus mirabilis
• Escherichia coli
• Pseudomonas aeruginosa
• Adenovirus
• Herpes simplex virus
• Herpes zoster virus

• 2. Conjunctivitis, neonatal prophylaxis

• Preferred regimen: 0.5% Erythromycin ophthalmic ointment, single dose
• Alternative regimen: 2.5% Providone-iodine solution ophthalmic ointment, single dose

• 3. Empiric antimicrobial therapy

• Preferred regimen: Gentamicin/Tobramycin 0.3% ophthalmic ointment q2h to qid for 1 week
• Alternative regimen (1): Bacitracin zinc 500U/g ophthalmic ointment qhs to qid for 1 week
• Alternative regimen (2): Chloramphenicol 1.0% ophthalmic ointment q2h to qid for 1 week OR Chloramphenicol 0.5% solution q2h to qid for 1 week
• Alternative regimen (3): Erythromycin 0.5% ophthalmic ointment qhs to qid for 1 week OR Azithromycin 1% ophthalmic ointment bid for 2 days then qd for 5 days
• Alternative regimen (4): Ciprofloxacin 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week OR Ofloxacin 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week OR Levofloxacin 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week OR Moxifloxacin 0.5% ophthalmic ointment bid to tid for 1 week OR Besifloxacin 0.6% ophthalmic suspension tid for 1 week OR Gatifloxacin 0.5% ophthalmic solution tid for 1 week
• Alternative regimen (5): Polymyxin B/Trimethoprim sulfate 10,000 U, 1 mg/mL ophthalmic solution q3h for 1 week
• Alternative regimen (6): Polymyxin B/Neomycin 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week
• Alternative regimen (7): Sodium sulfacetamide 10%-30% ophthalmic solution q2hr to qid for 1 week
• Alternative regimen (8): Sulfisoxazole diolamine 4.0% ophthalmic solution qid for 1 week
• Alternative regimen (9): Tetracycline 1.0% ophthalmic ointment q2h to qid for 1 week
• Note (1): All regimens have similar efficacy.
• Note (2): When empiric antimicrobial therapy is administered, the patient's age, environment, and related ocular findings may guide the treatment of choice.
• Note (3): Some regimens are associated with transient blurring of vision.
• Note (4): Topical steroids are not recommended for bacterial conjunctivitis.

• 4. Pathogen-directed antimicrobial therapy

• 4.1 Chlamydia trachomatis

• Preferred regimen: Azithromycin 1 g PO, single dose
• Alternative regimen: Doxycycline 100 mg PO bid for 7 days
• Pediatric regimen (1): Children who weigh < 45 kg: Erythromycin solution 50 mg/kg/day PO qid for 2 weeks OR Ethylsuccinate 50 mg/kg/day PO qid for 2 weeks
• Pediatric regimen (2): Chidren who weigh ≥ 45 kg but are aged < 8 years: Azithromycin 1 g PO, single dose
• Pediatric regimen (3): Children ≥ 8 years: Azithromycin solution 1 g PO, single dose OR Doxycycline 100 mg PO bid for 1 week
• Neonatal regimen: Erythromycin 50 mg/kg/day PO qid for 2 weeks OR Ethylsuccinate 50 mg/kg/day PO qid for 2 weeks
• Note: Neonates administered Erythromycin should be followed for signs and symptoms of infantile hypertrophic pyloric stenosis

• 4.2 Neisseria gonorrhoeae

• Hyperacute bacterial conjunctivitis, adult

• Preferred regimen: Ceftriaxone 25 mg IM, single-dose AND (Azithromycin 1 g PO, single dose OR Doxycycline 100 mg PO bid for 1 week)
• Alternative regimen, cephalosporin-allergic: [[Azithryomycin 2 g PO, single dose
• Pediatric dose: Children who weigh < 45 kg: Ceftriaxone 125 mg IM, single dose OR Spectinomycin 40 mg/kg (maximum dose 2 g) IM, single dose
• Neonatal dose: Ceftriaxone 25-50 mg/kg (maximum dose 125 mg) IV or IM, single dose
• Note: The regimen provides adequate coverage for both N. gonorrhea and C. trachomatis
• Note: Children who weigh > 45 kg are administered adult doses for the management of N. gonorrhoeae conjunctivitis

• 4.3 Staphylococcus aureus

• 4.3.1 Methicillin-sensitive Staphylococcus aureus (MSSA)

• Preferred regimen: Gentamicin/Tobramycin 0.3% ophthalmic ointment q2h to qid for 1 week OR Bacitracin zinc 500U/g ophthalmic ointment qhs to qid for 1 week OR Chloramphenicol 1.0% ophthalmic ointment q2h to qid for 1 week OR Chloramphenicol 0.5% solution q2h to qid for 1 week OR Erythromycin 0.5% ophthalmic ointment qhs to qid for 1 week OR Azithromycin 1% ophthalmic ointment bid for 2 days then qd for 5 days OR Ciprofloxacin 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week OR Ofloxacin 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week OR Levofloxacin 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week OR Moxifloxacin 0.5% ophthalmic ointment bid to tid for 1 week OR Besifloxacin 0.6% ophthalmic suspension tid for 1 week OR Gatifloxacin 0.5% ophthalmic solution tid for 1 week OR Polymyxin B/Neomycin 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week OR Polymyxin B/Neomycin 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week OR Tetracycline 1.0% ophthalmic ointment q2h to qid for 1 week

• 4.3.2 Methicillin-resistant Staphylococcus aureus (MRSA)

• Preferred regimen: Vancomycin 1% ophthalmic ointment qid for 2 weeks

• 4.3.3 Methicillin-sensitive Staphylococcus epidermidis (MSSE)

• Preferred regimen: Gentamicin/Tobramycin 0.3% ophthalmic ointment q2h to qid for 1 week OR Bacitracin zinc 500U/g ophthalmic ointment qhs to qid for 1 week OR Chloramphenicol 1.0% ophthalmic ointment q2h to qid for 1 week OR Chloramphenicol 0.5% solution q2h to qid for 1 week OR Erythromycin 0.5% ophthalmic ointment qhs to qid for 1 week OR Azithromycin 1% ophthalmic ointment bid for 2 days then qd for 5 days OR Ciprofloxacin 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week OR Ofloxacin 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week OR Levofloxacin 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week OR Moxifloxacin 0.5% ophthalmic ointment bid to tid for 1 week OR Besifloxacin 0.6% ophthalmic suspension tid for 1 week OR Gatifloxacin 0.5% ophthalmic solution tid for 1 week OR Polymyxin B/Neomycin 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week OR Polymyxin B/Neomycin 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week OR Tetracycline 1.0% ophthalmic ointment q2h to qid for 1 week

• 4.3.4 Methicillin-resistant Staphylococcus aureus (MRSE)

• Preferred regimen: Vancomycin 1% ophthalmic ointment qid for 2 weeks

• 4.4 Streptococcus species

• 4.4.1 Streptococcus pnuemoniae
• Preferred regimen: Gentamicin/Tobramycin 0.3% ophthalmic ointment q2h to qid for 1 week OR Bacitracin zinc 500U/g ophthalmic ointment qhs to qid for 1 week OR Erythromycin 0.5% ophthalmic ointment qhs to qid for 1 week OR Azithromycin 1% ophthalmic ointment bid for 2 days then qd for 5 days

• Herpetic conjunctivitis

• Herpes simplex virus

• Preferred regimen: Acyclovir 1 drop topical 9 times per day OR Acyclovir 400 mg PO 5 times per day for 7-10 days OR Valacyclovir 500 mg PO tid for 7-10 days

Note: Topical steroids should be avoided.

• Varicella zoster virus

• Preferred regimen: Acyclovir 800 mg PO 5 times per day for 7-10 days OR Famciclovir 500 mg PO tid for 7-10 days OR Valacyclovir 1000 mg PO tid for 7-10 days

Note: Treatment usually consists of a combination of oral antivirals and topical steroids.

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