The application of azithromycin solution in the treatment of inflammatory eye diseases in the practice of pediatricians and general practitioners of family medicine (literature review)
DOI:
https://doi.org/10.15574/SP.2025.2(146).7886Keywords:
newborn, children, bacterial conjunctivitis, diagnosis, treatment, an aqueous solution of azithromycinAbstract
The presented review is devoted to modern views on the mechanisms of development, diagnosis, prevention, and treatment of inflammatory eye diseases in children.
The aim is the systematization of pediatric patients’ management data with inflammatory eye diseases at the outpatient stage of medical care by pediatricians and general practitioners/family medicine physicians.
Most cases of inflammation of the eye surface in children are caused by bacterial conjunctivitis. Conjunctivitis in newborns occupies a special place, that is caused by the specificity of pathogens in the postnatal period. The article highlights the dynamics and duration of neonatal conjunctivitis, clinical manifestations and consequences depending on the pathogen, global data on the spread of the disease, and a comparison of the effectiveness of different treatment approaches. The main symptoms of conjunctivitis in children are covered thoroughly, in particular, the duration of the disease, the involvement of one or both eyes, the nature of the discharge from the eye (eyes), and accompanying signs that may help in the determination of the etiology. The article discusses approaches to the differential diagnosis of conjunctivitis, as well as the causes of eye hyperemia as the main clinical symptom. To unify the management of pediatric patients with bacterial conjunctivitis at the outpatient stage of medical care and based on evidence-based recommendations, the authors proposed a diagnostic and treatment algorithm for a child presenting eye redness. The pharmacological aspects of the application of azithromycin are considered. Research data on the activity and effectiveness of 1.5% aqueous solution of azithromycin in the form of eye drops and an aqueous solution of tobramycin are presented.
The authors made a conclusion that it is advisable to apply a 1.5% aqueous solution of azithromycin in the form of eye drops for the treatment of bacterial conjunctivitis, dacryocystitis, and chalazion in children.
The authors declare no conflict of interest.
References
Bielory L, Delgado L, Katelaris CH, Leonardi A, Rosario N, Vichyanoud P. (2020). ICON: Diagnosis and management of allergic conjunctivitis. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 124(2): 118-134. https://doi.org/10.1016/j.anai.2019.11.014; PMid:31759180
Boadi-Kusi SB, Kyei S, Holdbrook S, Abu EK, Ntow J, Ateko AM. (2021). A study of Ophthalmia Neonatorum in the Central Reion of Ghana: Causative Agents and Antibiotic Susceptibility Patterns. Global pediatric health. 8: 2333794X211019700. https://doi.org/10.1177/2333794X211019700; PMid:34104699 PMCid:PMC8165866
Bobrova N et al. (2024). Pathogens and Antibacterial Therapy in Pediatric Bacterial Conjunctivitis, Dacryocystitis and Chalazion. EC Ophthalmology. 15(9): 01-08.
Boffa MM, Spiteri A. (2020). Haemolacria: a case of pseudomembranous conjunctivitis in a neonate. BMJ case reports. 13(6): e235110. https://doi.org/10.1136/bcr-2020-235110; PMid:32606124 PMCid:PMC7328758
Bothun CE, Mansukhani SA, Xu TT, Hendricks TM, Hodge DO, Mohney BG. (2022). Incidence and Clinical Characteristics of Infantile Conjunctivitis in a Western Population. American journal of ophthalmology. 241: 145-148. https://doi.org/10.1016/j.ajo.2022.04.008; PMid:35469786 PMCid:PMC10441006
Bremond-Gignac D, Nezzar H, Bianchi PE, Messaoud R, Lazreg S, Voinea L et al. (2014). Efficacy and safety of azithromycin 1.5% eye drops in paediatric population with purulent bacterial conjunctivitis. The British journal of ophthalmology. 98(6): 739-745. https://doi.org/10.1136/bjophthalmol-2013-303888; PMid:24526744 PMCid:PMC4033170
CDC. (2024) Clinical Overview of Pink Eye (Conjunctivitis). URL: https://www.cdc.gov/conjunctivitis/hcp/clinical-overview/index.html.
Comité Consultivo de Infecciones Neonatales, Sociedad Chilena de Infectología (2017). Racionalidad de la profilaxis ocular de la oftalmia neonatalen el recién nacido [Rationale of ocular prophylaxis of neonatal ophtalmia in the newborn infant]. Revista chilena de infectologia : organo oficial de la Sociedad Chilena de Infectologia. 34(3): 257-258. https://doi.org/10.4067/S0716-10182017000300008; PMid:28991322
Compendium drug reference book. Azithromycinum. URL: https://compendium.com.ua/uk/akt/65/3349/azithromycinum/.
Esra N, Hollhumer R. (2021). Herpes Simplex Virus-Related Conjunctivitis Resistant to Aciclovir: A Case Report and Review of the Literature. Cornea. 40(8): 1055-1058. https://doi.org/10.1097/ICO.0000000000002613; PMid:33264148
Honkila M, Koskela U, Kontiokari T, Mattila ML, Kristo A, Valtonen R et al. (2022). Effect of Topical Antibiotics on Duration of Acute Infective Conjunctivitis in Children: A Randomized Clinical Trial and a Systematic Review and Meta-analysis. JAMA network open. 5(10): e2234459. https://doi.org/10.1001/jamanetworkopen.2022.34459; PMid:36194412 PMCid:PMC9533187
Isenberg SJ, Apt L, Wood M. (1996). The influence of perinatal infective factors on ophthalmia neonatorum. Journal of pediatric ophthalmology and strabismus. 33(3): 185-188. https://doi.org/10.3928/0191-3913-19960501-13; PMid:8771523
Johnson D, Liu D, Simel D. (2022). Does This Patient With Acute Infectious Conjunctivitis Have a Bacterial Infection? The Rational Clinical Examination Systematic Review. JAMA. 327(22): 2231-2237. https://doi.org/10.1001/jama.2022.7687; PMid:35699701
Kaštelan S, Anić Jurica S, Orešković S, Župić T, Herman M, Gverović Antunica A et al. (2018). A Survey of Current Prophylactic Treatment for Ophthalmia Neonatorum in Croatia and a Review of International Preventive Practices. Medical science monitor : international medical journal of experimental and clinical research. 24: 8042-8047. https://doi.org/10.12659/MSM.910705; PMid:30413681 PMCid:PMC6240167
Kates MM, Tuli S. (2021). Complications of Contact Lenses. JAMA. 325(18): 1912. https://doi.org/10.1001/jama.2020.20328; PMid:33974017
Khan, A., Anders, A., & Cardonell, M. (2022). Neonatal Conjunctivitis. NeoReviews, 23(9), e603-e612. https://doi.org/10.1542/neo.23-9-e603; PMid:36047752
Kreisel K, Weston E, Braxton J, Llata E, Torrone E. (2017). Keeping an Eye on Chlamydia and Gonorrhea Conjunctivitis in Infants in the United States, 2010-2015. Sexually transmitted diseases. 44(6): 356-358. https://doi.org/10.1097/OLQ.0000000000000613; PMid:28499285 PMCid:PMC5527667
Lambert SR, Taylor D, Hoyt CS. (2005). Conjunctivitis of the newborn: ophthalmia neonatorum. In: Wright KE, Spiegel PH, Hengst TC, editors. Pediatric ophthalmology and strabismus. Philadelphia: Elsevier's Saunders: 146-148.
LeFevre ML, U.S. Preventive Services Task Force. (2014). Screening for Chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Annals of internal medicine. 161(12): 902-910. https://doi.org/10.7326/M14-1981; PMid:25243785
Mahoney MJ, Bekibele R, Notermann SL, Reuter TG, Borman-Shoap EC. (2023). Pediatric Conjunctivitis: A Review of Clinical Manifestations, Diagnosis, and Management. Children (Basel, Switzerland). 10(5): 808. https://doi.org/10.3390/children10050808; PMid:37238356 PMCid:PMC10217501
Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G. (2008). Neonatal conjunctivitis - a review. Malaysian family physician : the official journal of the Academy of Family Physicians of Malaysia. 3(2): 77-81.
Maqsood N, Mahmood U. (2020). Herpes simplex ophthalmia neonatorum: a sight-threatening diagnosis. The British journal of general practice : the journal of the Royal College of General Practitioners. 70(699): 513-514. https://doi.org/10.3399/bjgp20X712973; PMid:33004377 PMCid:PMC7518920
Matejcek A, Goldman RD. (2013). Treatment and prevention of ophthalmia neonatorum. Canadian family physician Medecin de famille canadien. 59(11): 1187-1190.
Ministry of Health of Ukraine. (2023). Shhorichnyj zvit pro stan zdorov'ja naselennja Ukrajiny ta epidemichnu sytuaciju za 2022 rik: 39.
Mondì V, Tzialla C, Aversa S, Merazzi D, Martinelli S, Araimo G et al. (2023). Antibiotic prophylaxis for ophthalmia neonatorum in Italy: results from a national survey and the Italian intersociety new position statements. Italian journal of pediatrics. 49(1): 117. https://doi.org/10.1186/s13052-023-01507-7; PMid:37697419 PMCid:PMC10494339
Moore DL, MacDonald NE, Canadian Paediatric Society, Infectious Diseases and Immunization Committee. (2015). Preventing ophthalmia neonatorum. Paediatrics & child health. 20(2): 93-96.
Nasiri N, Sharifi H, Bazrafshan A, Noori A, Karamouzian M, Sharifi A. (2021). Ocular Manifestations of COVID-19: A Systematic Review and Meta-analysis. Journal of ophthalmic & vision research. 16(1): 103-112. https://doi.org/10.18502/jovr.v16i1.8256; PMid:33520133 PMCid:PMC7841281
Pérez-Chimal LG, Cuevas GG, Di-Luciano A, Chamartín P, Amadeo G, Martínez-Castellanos MA. (2021). Ophthalmic manifestations associated with SARS-CoV-2 in newborn infants: a preliminary report. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus. 25(2): 102-104. https://doi.org/10.1016/j.jaapos.2020.11.007; PMid:33601042 PMCid:PMC7884229
Pomeranz AJ, Sabnis S, Busey S, Kliegman R. (2016). Pediatric decision-making strategies, second edition. Publisher. Elsevier/Saunders. ISBN: 978-0-323-29854-4.
Sebastian T, Frost HM. (2022). A qualitative evaluation of pediatric conjunctivitis medical decision making and opportunities to improve care. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus. 26(3): 113.e1-113.e6. https://doi.org/10.1016/j.jaapos.2021.12.008; PMid:35421542 PMCid:PMC10119943
Smadar L, Dotan G, Abumanhal M, Achiron A, Spierer O. (2020). Demographic, clinical features, and outcomes of pediatric non-penetrating ocular foreign bodies. Graefe's archive for clinical and experimental ophthalmology - Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie. 258(7): 1469-1474. https://doi.org/10.1007/s00417-020-04688-7; PMid:32296989
US Preventive Services Task Force, Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB et al. (2019). Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA. 321(4): 394-398. https://doi.org/10.1001/jama.2018.21367; PMid:30694327
Weatherby T. (2021). Relative frequencies of ophthalmia neonatorum and congenital nasolacrimal duct obstruction The British journal of general practice : the journal of the Royal College of General Practitioners. 71(703): 59. https://doi.org/10.3399/bjgp21X714905; PMid:33509832 PMCid:PMC7846369
Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I et al. (2021). Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports. 70(4): 1-187. https://doi.org/10.15585/mmwr.rr7004a1; PMid:34292926 PMCid:PMC8344968
Zuppa AA, D'Andrea V, Catenazzi P, Scorrano A, Romagnoli C. (2011). Ophthalmia neonatorum: what kind of prophylaxis? The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 24(6): 769-773. https://doi.org/10.3109/14767058.2010.531326; PMid:21534852
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