Managing Eye Medications for Children with Favism: Key Considerations

Medication issues related to Favism (G6PD deficiency) and eye care?

If a child has favism and is experiencing frequent tearing, they visited an ophthalmologist who diagnosed them with keratitis (or conjunctivitis) and prescribed eye drops (Oasis's anti-fungal) and ointment (Oasis's chloramphenicol).
Since the child's grandmother took them to the appointment, it is unclear whether the doctor was informed about the favism condition.
After researching online, it appears that chloramphenicol should not be used in patients with favism.
Additionally, what are the potential side effects of gentamicin on an infant (over 5 months old)? The child received a dose of the eye drops at noon, and by evening, there were noticeable red streaks in the eyes, which may be a reaction to the medication.
We are unsure of the next steps and would appreciate any recommendations.
Thank you.

Darwin, 30~39 year old female. Ask Date: 2010/02/06

Dr. Xiao Kaiwen reply Pediatrics

In patients with G6PD deficiency (favism), only sulfonamide antibiotics should be avoided, as aminoglycosides and chloramphenicol do not fall into this category and therefore have no impact on the condition.
The dosage of GENTAMICIN eye drops should not cause side effects in infants.
If there are noticeable red streaks in the eyes, it can be monitored, and if necessary, a consultation with a pediatrician or ophthalmologist can be sought.

Reply Date: 2010/02/06

More Info

Managing eye medications for children with favism, or glucose-6-phosphate dehydrogenase (G6PD) deficiency, requires careful consideration due to the potential for adverse reactions to certain medications. Favism is a hereditary condition that can lead to hemolytic anemia when individuals consume fava beans or are exposed to certain drugs, including some antibiotics.
In your case, the child has been diagnosed with keratitis or conjunctivitis and has been prescribed chloramphenicol ointment and an antibiotic eye drop containing gentamicin. It is crucial to note that chloramphenicol is contraindicated in patients with G6PD deficiency due to the risk of hemolytic anemia. This antibiotic can cause oxidative stress, which can trigger hemolysis in susceptible individuals. Therefore, it is essential to inform the prescribing physician about the child's G6PD deficiency to reconsider the medication choice.

Gentamicin, while generally considered safe, can also have side effects, particularly in infants. The most common side effects include local irritation, redness, and allergic reactions. The appearance of red blood vessels in the child's eyes after administering the gentamicin may indicate a reaction to the medication or an exacerbation of the underlying condition. It is essential to monitor the child closely for any worsening symptoms or new side effects.

Here are some key considerations for managing eye medications in children with favism:
1. Medication Review: Always review the medications prescribed to ensure they are safe for children with G6PD deficiency. Avoid using chloramphenicol and other known contraindicated drugs.

2. Consultation with Specialists: If there is any doubt about the safety of a prescribed medication, consult with a pediatrician or a pediatric ophthalmologist who is familiar with G6PD deficiency.

3. Monitoring for Side Effects: After starting any new medication, monitor the child for any adverse reactions. This includes watching for increased redness, swelling, or discharge from the eyes, as well as systemic symptoms like fever or lethargy.

4. Alternative Treatments: If the prescribed medications are not suitable, discuss alternative treatments with the healthcare provider. There may be other effective antibiotics or topical treatments that are safe for children with G6PD deficiency.

5. Emergency Plan: Have a plan in place in case of severe reactions, including knowing when to seek immediate medical attention.

6. Education: Educate caregivers about the signs of hemolytic anemia, which may include jaundice, dark urine, fatigue, and pallor. If any of these symptoms occur, seek medical attention promptly.

In summary, it is crucial to communicate the child's G6PD deficiency to the healthcare provider and to seek alternatives to chloramphenicol. Monitoring for side effects from gentamicin is also essential. If there are any concerns about the child's condition or the effectiveness of the treatment, do not hesitate to follow up with the healthcare provider for further evaluation and management.

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