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AI-Generated response:

When should I consider treating conjunctivitis as fungal in a child?

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

Consider treating conjunctivitis as fungal in a child if there is a history of prolonged corticosteroid use, presence of persistent corneal ulceration, or failure to improve after initial treatment with antibacterial agents, as fungal infections can develop coincidentally with long-term corticosteroid applications.[1-3]

  • Fungal conjunctivitis should be suspected in cases where there is no improvement after two days of treatment with typical antibacterial or anti-inflammatory agents.[1-3]

  • Persistent fungal infections of the cornea are a risk with prolonged corticosteroid dosing, necessitating careful examination and possibly fungal cultures.[1-3]

  • Natamycin is indicated for fungal blepharitis and fungal conjunctivitis, but its safety and efficacy in children have not been established.[4]

  • When using corticosteroids like dexamethasone or combination products containing dexamethasone, monitor for signs of fungal infection, especially in persistent corneal ulceration.[1-3]

  • Re-evaluation of the patient should be done using slit lamp biomicroscopy and fluorescein staining if there is no improvement or if fungal infection is suspected.[1-3]

Additional info

In the context of pediatric conjunctivitis, it is crucial to differentiate between bacterial, viral, and fungal etiologies, as the treatment strategies differ significantly. Fungal conjunctivitis, although less common than bacterial or viral forms, can occur under certain conditions such as prolonged use of topical corticosteroids or in immunocompromised children. The use of corticosteroids can suppress the immune response and alter the normal flora, facilitating fungal overgrowth. If a child presents with conjunctivitis that does not respond to standard antibacterial treatments, or if there is an associated corneal involvement particularly with ulceration, fungal etiology should be considered. Diagnostic confirmation through laboratory cultures can be essential for appropriate management. In such cases, antifungal therapy may be initiated based on clinical suspicion and adjusted according to culture results. However, the use of natamycin in children for fungal infections, as noted, lacks established safety and efficacy data, necessitating cautious use and consideration of alternative treatments or specialist referral.[4]

References

Reference 1

1.

Food and Drug Administration (DailyMed).

Publish date: April 4, 2023.

General Precautions General FOR TOPICAL OPHTHALMIC USE. The possibility of persistent fungal infections of the cornea should be considered after prolonged corticosteroid dosing. The initial prescription and renewal of the medication order should be made by a physician only after examination of the patient with the aid of magnification, such as slit lamp biomicroscopy and, where appropriate, fluorescein staining. If signs and symptoms fail to improve after 2 days, the patient should be re-evaluated.

Reference 2

2.

Food and Drug Administration (DailyMed).

Publish date: December 3, 2018.

General Precautions General The initial prescription and renewal of the medication order beyond 20 mL of Neomycin and Polymyxin B Sulfates and Dexamethasone Ophthalmic Suspension should be made by a physician only after examination of the patient with the aid of magnification, such as slit lamp biomicroscopy and, where appropriate, fluorescein staining. If signs and symptoms fail to improve after two days, the patient should be re-evaluated. As fungal infections of the cornea are particularly prone to develop coincidentally with long-term local corticosteroid applications, fungal invasion should be suspected in any persistent corneal ulceration where a corticosteroid has been used or is in use. Fungal cultures should be taken when appropriate. If this product is used for 10 days or longer, intraocular pressure should be monitored (see WARNINGS ). Prolonged use of topical antibacterial agents may give rise to overgrowth of nonsusceptible organisms including fungi.

Reference 3

3.

Food and Drug Administration (DailyMed).

Publish date: January 2, 2022.

Precautions General The initial prescription and renewal of the medication order beyond 20 mL of neomycin and polymyxin B sulfates and dexamethasone ophthalmic suspension should be made by a physician only after examination of the patient with the aid of magnification, such as slit lamp biomicroscopy, and where appropriate, fluorescein staining. If signs and symptoms fail to improve after two days, the patient should be reevaluated. As fungal infections of the cornea are particularly prone to develop coincidentally with long-term corticosteroid applications, fungal invasion should be suspected in any persistent corneal ulceration where a corticosteroid has been used or is in use. Fungal cultures should be taken when appropriate. If this product is used for 10 days or longer, IOP should be monitored (see WARNINGS). Prolonged use of topical anti-bacterial agents may give rise to overgrowth of nonsusceptible organisms including fungi. Information for Patients If inflammation or pain persists longer than 48 hours or becomes aggravated, the patient should be advised to discontinue use of the medication and consult a physician. This product is sterile when packaged. To prevent contamination, care should be taken to avoid touching the bottle tip to eyelids or to any other surface. The use of this bottle by more than one person may spread infection. Keep bottle tightly closed when not in use. Keep out of reach of children. Patients should be advised that their vision may be temporarily blurred following dosing with neomycin and polymyxin B sulfates and dexamethasone ophthalmic suspension. Care should be exercised in operating machinery or driving a motor vehicle.

Reference 4

4.

Elsevier ClinicalKey Drug Monograph

Content last updated: September 5, 2023.

Indications And Dosage **For the treatment of fungal blepharitis and fungal conjunctivitis** Ophthalmic dosage Adults and Geriatric: Instill 1 drop topically into conjunctival sac every 4—6 hours. Duration of therapy should be based on clinical reevaluation and additional laboratory results. Neonates, Infants, Children, and Adolescents: Safety and efficacy have not been established.

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