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Bacterial Conjunctivitis in Children: Antibacterial Treatment Options in an Era of Increasing Drug Resistance

Conjunctivitis is one of the most frequently seen eye disorders in the primary care and pediatric setting, accounting for an estimated 1% to 4% of visits. The etiology can be bacterial, viral, allergic, or chemical, but bacterial infections are the most common. Bacterial conjunctivitis occurs more often in preschool children than in older children and adults. The most common causative organisms in children are Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, and Moraxella catarrhalis (Table 1). Approximately one third of children with bacterial conjunctivitis have concurrent otitis media. Bacterial conjunctivitis is highly contagious and rapidly transmitted in day-care centers and classrooms. The condition is typically self-limited, with clinical resolution usually apparent by 7 days without treatment. However, clearance of the infection can take up to 3 weeks. Treatment of acute bacterial conjunctivitis with an antiinfective agent lessens contagion and duration of disease, alleviates patient discomfort, and facilitates earlier resumption of normal activities. A meta-analysis of 5 double-blind, placebo-controlled clinical studies with a total of 1034 children and adults concluded that antibacterial agents have their greatest impact on clinical and microbiological remission if begun within 2 to 5 days of symptom onset. As bacterial resistance to anti-infectives continues to evolve, the selection of an ocular antibacterial has become a challenge. Bacterial resistance to antibiotic therapy can result from a number of factors. Nationwide surveillance studies such as the Ocular Tracking Resistance in US Today (TRUST) survey and The Surveillance Network (TSN) have documented emerging resistance among ocular pathogens to ocular anti-infectives. In this review, the differential diagnosis of bacterial conjunctivitis in children and the efficacy of currently used and newer topical antibacterial treatments for acute bacterial conjunctivitis in the preschool and school-aged child will be presented in the context of increasing bacterial resistance.