Conjunctivitis (peds): Difference between revisions

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==[[Neonatal conjunctivitis]]==
==Background==
===Background===
*Vesicles + conjunctivitis = full sepsis eval + acyclovir


===Diagnosis===
==Differential Diagnosis==
*Chlamydial
**Can range from mild to severe hyperemia w/ thick mucopurulent discharge
*Gonococcal
**May present as typical conjunctivitis or w/ severe lid edema, cornea ulceration
===Work-Up===
*Gram stain/culture to r/o gonorrhea
 
===DDx===
*Chemical
**Due to ocular prophylaxis
**Occurs on 1st day of life
*Gonococcal
**Peaks at 3-5 days after birth
**Has potential to cause loss of vision
*Chlamydia
**Peaks from 1wk to 1 month after birth
*Herpetic
**Peaks at 6-14 days of life
**May lead to keratitis and disseminated infection
 
===Treatment===
*Gonococcal
**Cefotaxime 100mg/kg IV or IM OR [[ceftriaxone]] 25-50mg/kg IV or IM x1 (not to exceed 125mg)
***Cefotaxime is preferred b/c does not displace bilirubin
**Disseminated disease should be suspected until CSF is negative
**Topical tx is unnecessary
*Chlamydial
**Erythromycin 50mg/kg PO QD in 4 divided doses x 14 days
**Topical tx is unnecessary
*Herpetic
**Acyclovir 20mg/kg IV q8hr x 14-21d
**Topical antiviral
**Full sepsis evaluation
*Chemical
**Watchful waiting
 
===Disposition===
*Gonococcal
**Admit
*Herpetic
**Admit
 
==[[Childhood conjunctivitis]]==
===DDX===
*Viral
*Viral
**Most frequently caused by adenovirus
**Most frequently caused by adenovirus
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*Pediculosis
*Pediculosis


===Treatment===
==Treatment==
*Viral
*Viral
**Non-herpetic: supportive care
**Non-herpetic: supportive care

Revision as of 18:14, 26 January 2015

Background

Differential Diagnosis

  • Viral
    • Most frequently caused by adenovirus
    • Herpes infection requires immediate treatment
  • Bacterial
    • Consider chlamydial and gonococcal, esp in adolescents
  • Allergic
  • Kawasaki Disease
  • Pediculosis

Treatment

  • Viral
    • Non-herpetic: supportive care
    • Herpetic: Acyclovir, ophto referral
  • Bacterial
    • If otitis media + conj give PO abx
    • If conj only give topical abx
      • Erythromycin ointment
        • Note: does not adequately cover H. flu and Moraxella
          • If tx failure switch to fluoroquinolone drops
  • Allergic
    • Ketotifen 1 drop q8-12hr OR olopatadine 1-2 drop QD

See Also

Source

Tintinalli

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