Although conjuncitivitis outside of the neonatal period is commonly caused by viruses, there are times when antibiotics are warranted due to bacterial infections, such as conjuncitivits-otitis syndrome.
up to 25% of patients with conjunctivitis have concurrent otitis media (even in the abscence of ear pain) and up to 73% of patients with purulent conjunctivitis
Non-typeable H. influenzae is the most common recovered bacteria.
For these patients, systemic (oral) antibiotics are recommended and the topical ophthalmic antibiotics are NOT necessary.
Antibiotics should cover beta-lactamase producing organisms, e.g. high dose amoxicillin-clavulanic acid (45 mg/kg BID; 600 mg/5mL concentration which is formulated to have less clavulanic acid
Bottom line: Every patient with conjunctivitis should have an examination of his/her TMs, as your management may change.
References
Teoh DL, Reynolds S. Diagnosis and management of pediatric conjunctivitis. Pediatric Emergency Care: 2003; 19(1), pp. 48-55.
Bodor FF, Marchant CD, Shurin PA, Barenkamp SJ. Bacterial etiology of conjunctivitis-otitis media syndrome. Pediatrics: 1985; 76(1), pp.26-28.
