Primary Bacterial Conjunctivitis (NOT blepharoconjunctivitis)

Question 1

Primary Bacterial Conjunctivitis (not blepharoconjunctivitis!)

Answer 1

chlorofluoroquinolone is Besivance gtt (besifloxacin [DuraSite] ) aminoglycosides gtt/ung (gentamycin, tobramycin, neomycin) polymyxin B combinations gtt/ung (Polysporin ung)
Polytrim gtt (polymyxin B + trimethoprim)
fluoroquinolone gtt/ung (see Top Abx Drugs), PO resistance other antibiotics, eg AzaSite gtt (azithromycin [DuraSite]) oral medications
additional treatment
treatment failure
true Primary Bacterial Conjunctivitis in non-ped/Senior Pts implies acquired immune dysfunction / deficiency

Question 2

What specific organism is associated with petechial hems and scant discharge?

Answer 2

Strep pneumoniae

Question 3

What specific organism is associated with copious discharge?

Answer 3

H. flu

Question 4

A child’s URI can be associated with what organism and how may the URI be treated?

Answer 4

H. flu?

treat with: amoxicillin/clavulante

Question 5

pathophysiology

Answer 5

Staph aureus (often associated with blepharitis, phlyctenules, marginal sterile infiltrates), Staph epidermidis, Strep pneumoniae, and Haemophilus influenzae (especially in children)

Question 6

treatment options

Answer 6

1. various gtt and ung are also possible (see Topical Antibiotic Drugs below), aminoglycosides are not first choice drugs in these infections
2. 10% sulfacetamide NOT recommended due to significant resistance by staphylococci (over 60%); peds will use 15% effective against H.flu
3. amoxicillin/clavulanate (Augmetin) PO3 is recommended in children to treat H.flu
4. small children MAY respond better to ung than to gtt; start with Polytrim gtt
   first and then consider an ung if necessary

Question 7

Additional treatment

Answer 7

a. warm compresses (enhances immune response)
b. irrigation
c. careful lid hygiene and prevention of spread of infection at home and at work
d. no school for children
e. no work or careful “quarantine” for adults at work
7. treatment failure
a. non-compliance
b. wrong choice of antibiotic for specific condition
c. resistant microorganisms; then order CULTURE and SENSITIVITY
d. premature discontinuation of therapy
e. other pathophysiologies underlying signs and symptoms, eg blepharoconjunctivitis

Question 8

clicnical pearls

Answer 8

1. discourage the routine use of antibiotics for viral or allergicconjunctivitis
   2. encourage the treatment of secondary bacterial blepharoconjunctivitis associated with lid and lacrimal drainage system disease