Conjunctivitis (peds): Difference between revisions
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Neonatal Conjunctivitis | ==Neonatal Conjunctivitis== | ||
==Background== | ===Background=== | ||
*Vesicles + conjunctivitis = full sepsis eval + acyclovir | *Vesicles + conjunctivitis = full sepsis eval + acyclovir | ||
==Diagnosis== | ===Diagnosis=== | ||
*Chlamydial | *Chlamydial | ||
**Can range from mild to severe hyperemia w/ thick mucopurulent discharge | **Can range from mild to severe hyperemia w/ thick mucopurulent discharge | ||
*Gonococcal | *Gonococcal | ||
**May present as typical conjunctivitis or w/ severe lid edema, cornea ulceration | **May present as typical conjunctivitis or w/ severe lid edema, cornea ulceration | ||
==Work-Up== | ===Work-Up=== | ||
*Gram stain/culture to r/o gonorrhea | *Gram stain/culture to r/o gonorrhea | ||
==DDx== | ===DDx=== | ||
*Chemical | *Chemical | ||
**Due to ocular prophylaxis | **Due to ocular prophylaxis | ||
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**May lead to keratitis and disseminated infection | **May lead to keratitis and disseminated infection | ||
==Treatment== | ===Treatment=== | ||
*Gonococcal | *Gonococcal | ||
**Cefotaxime 100mg/kg IV or IM OR CTX 25-50mg/kg IV or IM x1 (not to exceed 125mg) | **Cefotaxime 100mg/kg IV or IM OR CTX 25-50mg/kg IV or IM x1 (not to exceed 125mg) | ||
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**Watchful waiting | **Watchful waiting | ||
==Disposition== | ===Disposition=== | ||
*Gonococcal | *Gonococcal | ||
**Admit | **Admit | ||
*Herpetic | *Herpetic | ||
**Admit | **Admit | ||
==Childhood Conjunctivitis== | |||
===DDX=== | |||
*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 | |||
==Source== | ==Source== | ||
Revision as of 19:42, 14 June 2011
Neonatal Conjunctivitis
Background
- Vesicles + conjunctivitis = full sepsis eval + acyclovir
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 CTX 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
- Cefotaxime 100mg/kg IV or IM OR CTX 25-50mg/kg IV or IM x1 (not to exceed 125mg)
- 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
- 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
- Note: does not adequately cover H. flu and Moraxella
- Erythromycin ointment
- Allergic
- Ketotifen 1 drop q8-12hr OR olopatadine 1-2 drop QD
Source
Tintinalli