A 13-year-old boy is brought to clinic by his parents due to copious, purulent discharge from his right eye. The patient's eye was crusted shut this morning. His father was able to open the eye by wiping it with a damp washcloth. The patient went to school but was sent home by the school nurse. He has not had ocular pain, visual changes, or fever. He lives at home with his parents and older sister, none of whom have similar symptoms. The patient has mild myopia and wears contact lenses. He takes loratadine daily for seasonal allergies. Vital signs are within normal limits. Examination shows conjunctival erythema and yellow exudate in the right eye. The conjunctiva of the left eye is also erythematous, but there are no secretions. Visual acuity testing with the patient's contacts removed shows 20/80 vision in both eyes, consistent with his well-child examination at age 12. Item 1 of 3
Which of the following is the most appropriate pharmacotherapy?

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Explanation: 11ec2b69_c00c_b003_8f63_c12683d1b857_MD0005_00 Bacterial conjunctivitis is highly contagious and presents with conjunctival erythema and mucopurulent discharge. The discharge is often thick and accumulates quickly, causing matting of the eyelid. The condition is often unilateral although it can be bilateral. Bacterial conjunctivitis is usually self-limited, but topical antibiotics are prescribed to shorten symptom duration and reduce person-to-person transmission. The most common causes of bacterial conjunctivitis are Staphylococcus aureus, Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae. First-line treatment is typically erythromycin ointment or polymyxin-trimethoprim drops. However, the incidence of Pseudomonas aeruginosa conjunctivitis is much higher among contact lens wearers, such as this child. Therefore, topical fluoroquinolones (eg, ciprofloxacin, ofloxacin) are preferred for contact lens wearers; erythromycin, macrolides (Choice E), and polymyxin-trimethoprim have limited activity against P aeruginosa. (Choice A) Topical antihistamines are used for allergic conjunctivitis, which is characterized by watery discharge and usually involves both eyes. Prominent pruritus can also help to distinguish allergic conjunctivitis from infectious conjunctivitis. (Choice B) Topical corticosteroids are used for certain inflammatory eye conditions (eg, uveitis) but are generally not used for conjunctivitis as they may cause the infection to worsen. (Choice D) Topical lubrication can help with dry eyes or corneal abrasions, but is not effective therapy for bacterial conjunctivitis. Educational objective: First-line therapy for bacterial conjunctivitis is erythromycin ointment or polymyxin-trimethoprim drops. However, fluoroquinolones are preferred for contact wearers due to higher risk for pseudomonal infection. References: Bacterial conjunctivitis. (http://www.ncbi.nlm.nih.gov/pubmed/22348418) Conjunctivitis. (http://www.ncbi.nlm.nih.gov/pubmed/26319341)

A 13-Year-Old Boy Is Brought to Clinic by His Parents