Objectives:
- Appropriately assess individuals presenting with symptoms consistent with
bacterial conjunctivitis and construct a comprehensive differential diagnosis.
- Recognize current resistance patterns to ocular antibiotics commonly used to treat this condition
- Evaluate treatment options in light of current pathogen mix and antibiotic resistance
Introduction:
Conjunctivitis, or inflammation of the conjunctiva. is the most frequently seen eye
disorder in the primary care and pediatric settings.[Leibowitz 2000; Morrow 1998;
Hovding 2008; Patel 2007] Acute infectious conjunctivitis accounts for an estimated
1% to 4% of primary care consultations in the developed world.[Reitveld 2004;
Sheikh & Hurwitz 2001]. The etiology of conjunctivitis can be bacterial, viral, fungal,
allergic, or chemical, [Hovding 2008; Morrow 1998] but bacterial conjunctivitis is the
most common etiology.
Bacterial conjunctivitis occurs more often in younger children
than in older children and adults [AAP Redbook 2006] and is seen in males and
females of all ages.[Diamant & Hwang, 1999; Sheikh & Hurwitz 2001] The most
common causative organisms in children are Haemophilus influenzae, Streptococcus
pneumoniae, Staphylococcus aureus, and Moraxella catarrhalis. [Rose 2005] These
pathogens, together with Staphylococcus aureus and Corynebacterium species, are
common to bacterial conjunctivitis in all age groups (Table 1). [Rose 2005; Tarabishy
2008]
Bacterial conjunctivitis is highly contagious and is rapidly transmitted in daycare
centers and classrooms. [Rose 2007; Morrow 1998; Patel 2007] The disease is
typically self-limiting, with clinical resolution usually apparent by 7 days in most
patients without treatment. [Rose 2007] However, clearance of the infection can take
up to 3 weeks in some patients.[Patel 2007] Treatment of acute bacterial
conjunctivitis with anti-infective agents lessens contagion and duration of disease,
alleviates patient discomfort, and facilitates earlier resumption of normal activities.
[Patel 2007] An analysis of 5 double-blind, placebo-controlled clinical studies with a
total of 1034 children and adult patients concluded that antibacterial agents have
their greatest impact on clinical and microbiological remission within 2 to 5 days.
[Sheikh & Hurwitz 2005]
However, bacterial resistance to systemic and ocular anti-infectives continues to
evolve, making the selection of an appropriate ocular antibacterial difficult and the
development of new anti-infectives with less potential for resistance imperative.
Because of this continually changing landscape, an update based on a literature
review is presented here on the differential diagnosis of bacterial conjunctivitis in
children; the increase of bacterial resistance and its effect on treatment selection. |
