PVP-I is a disinfectant and antiseptic agent with broad-spectrum antimicrobial activity against various viruses, bacteria, and fungi. It is routinely used in ophthalmic surgery.37 Advantages of PVP-I include low documented antibiotic resistance and effect on multiple pathogens in vitro.38 The combination of PVP-I and dexamethasone has the potential to treat both viral and bacterial conjunctivitis and also to address the inflammatory component of infectious conjunctivitis. Various combinations of PVP-I/dexamethasone have been studied or are currently under investigation for the treatment of inflammatory conditions associated with ocular infections.
Published data do not show a clear difference in corticosteroid response between the pediatric and adult populations, but pediatricians have been trained to avoid ocular steroid use because of the risk of potentiation of latent HSV infection and a lack of slit lamps to detect HSV keratitis, which is a contraindication for topical steroid use. Nevertheless, several ophthalmic corticosteroids have been approved for treatment in pediatric populations. For example, FML (fluorometholone 0.1%)44 and TobraDex36 are approved for use in children aged >2 years.
A 1980 Israeli study investigated IOP response in children (aged 4–19 years) treated with dexamethasone for 6 weeks. They found that the steroid-associated increase in IOP among children was similar to that in adults.45 A 1991 Japanese study reported that dexamethasone 0.1% temporarily raised IOP among children aged <10 years after 1 to 2 weeks of treatment, but not among children aged ≥10 years.46 A 1997 study among Chinese children aged <10 years reported that topical dexamethasone increased IOP more frequently, more severely, and more rapidly among children compared with what was previously reported for adults.47 Most children (89%) in this study achieved peak IOP within 8 days after dexamethasone treatment.
Corticosteroids, in combination with anti-infectives/antiseptics, have the potential to address both infectious and inflammatory components of acute infectious conjunctivitis. Some of these combination products could reduce the need for differential diagnosis of bacterial or adenoviral conjunctivitis, and available data show that they may be appropriate for use in both adult and pediatric populations. Perceived risks associated with corticosteroid use (eg, increased IOP, prolonged viral shedding, and HSV reactivation) are not supported by high-quality evidence in the literature, at least in some situations (eg, short-term use). In fact, a review of the literature indicates that topical corticosteroids have been shown to be efficacious and well tolerated when used for short periods, in combination with antibiotics, antiseptics, or anti-infectives. Future randomized clinical trials to investigate the effectiveness and safety of steroids in conjunctivitis treatment are needed.
The authors thank Ira Probodh, PhD, of Excel Medical Affairs, who provided medical writing assistance funded by Shire, a member of the Takeda group of companies.
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