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Topical fluoroquinolones remain best treatment of acute bacterial conjunctivitis
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IDC NY 2011
NEW YORK — Acute conjunctivitis in young children warrants topical therapy, and the newer topical fluoroquinolones are more potent and clear more rapidly than other classes of topical treatments, according to a presenter at the 24th Annual Infectious Diseases in Children Symposium.
The drawback, according to Janet R. Casey, MD, director of clinical research at Legacy Pediatrics, and assistant clinical professor of pediatrics at the University of Rochester in Rochester, N.Y., is that cost and formulary issues may force clinicians to use polymyxin combinations as first-line therapy.
Goals of treatment should include, among others, a faster return for the child to day care and school and for the parents to work. According to Casey, broad-spectrum antibiotics, preferably bactericidal, should be used because they provide the best overall benefits. She told the audience during a CME symposium sponsored by Alcon that these antimicrobials provide rapid kill of bacteria, which shortens the time to recovery and limits the spread of disease. They also reduce the risk of complications that can threaten the sight of a child and eliminate infection that can be miserable for the child because of the discharge.
Topical antibiotic classes indicated for use in children include aminoglycosides, polymyxin B combinations, macrolides and fluoroquinolones.
“Sulfonamides are no longer recommended,” Casey said.
Topical antibiotics provide broad coverage of bacteria and rapid bactericidal rate with low bacterial resistance and minimal toxicity to the eye. They also are not painful to the patient and offer a convenient dosing schedule.
“If a severe infection is persistent or recurring, the patient should be referred to an ophthalmologist,” Casey said. “The older fluoroquinolones like ciprofloxacin and ofloxacin are the best first-line choices, as they have good coverage, are bactericidal, rapid kill rates and are well tolerated. They also come in generic formulations, which is a cost savings. That leaves the newer floroquinolones for recurrent infections.”
Casey added that pediatricians should not be prescribing a steroid for patients with conjunctivitis.
Comparing topical vs. oral treatment of conjunctivitis, Casey said only one study to date has compared the efficacy of the two treatments, and the results indicated there is no proven benefit in preventing acute otitis media. The study compared cefixime (Suprax, Lupin Pharmaceuticals) with polymyxin/bacitracin.
“The same pathogen that is in the eye is in the ear,” Casey said. “But you will not prevent AOM in a child with conjunctivitis by treating them with an oral drug.”
Regarding use of fluoroquinolones and resistance, Casey said a study by Lichtenstein and colleagues reported that there is no risk of inducing resistance to Haemophilus influenzae, Streptococcus pneumoniae or S. aureus in the eye or distal body sites with topical ophthalmic moxifloxacin. Therefore, this is the treatment of choice.
“This was a great study that showed this treatment does not induce resistance,” she said.
Disclosure: Dr. Casey reports no relevant financial disclosures.
For more information:
- Casey JR. The armamentarium: spectrum of activity, potency, adherence. Presented at: the 24th Annual Infectious Diseases in Children Symposium; Nov. 19-20, 2011; New York.
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