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Increasing Antibiotic Resistance Among Pediatric Acute Bacterial Conjunctivitis Isolates:  2011 Update



  1. Appropriately assess individuals presenting with symptoms consistent with
    bacterial conjunctivitis and construct a comprehensive differential diagnosis.
  2. Recognize current resistance patterns to ocular antibiotics commonly used to treat this condition
  3. Evaluate treatment options in light of current pathogen mix and antibiotic resistance


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.

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