The clinical problem is redness, burning, and itching in both eyes of an 11-year-old male. The patient was diagnosed with bilateral bacterial conjunctivitis that needs to be cured. Clinical goals are as follows: to cure conjunctivitis and relieve the patient from its symptoms, eliminate the possibility of complications, and prevent the spread of infection to peers and parents. Warm compress could be applied to eyelids and discharge could be removed with a soft warm cloth soaked in warm water (AAO, 2013). Abstain from touching the eye and surrounding area with fingers or non-sterile objects. Instead, the usage of clean cloth patches and napkins should be encouraged (AAO, 2013). As for lifestyle modification, it is essential to avoid contact lenses and follow proper hygiene, especially while touching the eyes and the face. To prevent disease transmission, every family member should use separate towels and other personal items.
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American Academy of Ophthalmology (AAO) guide for conjunctivitis diagnosis and treatment was used. It was devised by MD members of AAO who are also board members of the Preferred Practice Patterns Committee. The guide was developed using evidence-based research from 143 academic sources. The recommendations are evidenced by clinical trials, cohort studies, and randomized controlled trials (AAO, 2013). Evidence quality is rated as either “good quality” or “moderate quality.” Recommendations are either strong or discretionary. The guidelines apply to patients of all ages (AAO, 2013). A range of antibiotics may be used in this particular case. According to Epling (2012), polymyxin B gramicidin eye drops efficiently eliminate the symptoms.
AAO suggests applying erythromycin 0.5% eye ointment q.i.d for 7-10 days. The use of ointments is preferable for infants and younger children (AAO, 2013). However, an 11-year-old boy may safely use drops. According to AAO, an appropriate dosage of Erythromycin 0.5% ointment is a portion of ointment 1 cm in length (AAO, 2013; CRNBC, 2016). If drops are used, 2-3 drops q.i.d. should be sufficient (CRNBC, 2016). The choice of medication is justified by the strong recommendation of AAO. Compared to other antibiotics, it is more beneficial considering the relatively low cost and high efficiency. More to the point, erythromycin is well tolerated and has a few side effects. The cost of this drug starts from $18.92. It is available at Walmart with a free discount.
Scheduling a follow-up visit in two days will help to assess the progression or regression of infection. Other treatments may be affected if the initial one did not affect. 1-2 week follow-up is to be ensured to eliminate reappearance and transmission of the disease. Post-treatment analysis such as in-office rapid antigen testing should be used to determine the viral causes of conjunctivitis. The reduced expression of itching, burning, and redness will also serve as indicators of the prescribed medication effectiveness. Provided the patient and his caregiver followed the instructions on treatment and lifestyle changes, there should be no side-effects. However, if a patient is allergic to a certain component of the drug, the treatment should be stopped, and new intervention should be planned. Drug-food relationships are non-existent as the drug (ointment) is applied on the surface of the eye and not administered orally. Drug-drug interactions are also not an issue as the patient does not receive any other medications. Also, his present condition does not require additional medication other than what was already prescribed.
Several instructions are to be given to the patient:
- The dosage and frequency of administration are to be explained to the caregiver;
- Advise the patient and the caregiver not to contaminate the tube;
- Caregivers should be instructed that under no circumstances other people’s ointments or drops should be used;
- Usage of contact lenses must be paused until the symptoms are completely eradicated;
- Face towels should not be shared by members of the family until the disease is cured.
American Academy of Ophthalmology (AAO). (2013). Conjunctivitis PPP – 2013. Web.
College of Registered Nurses of British Columbia (CRNBC). (2016). Decision support tool: Conjunctivitis. Web.
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Epling, J. (2012). Bacterial conjunctivitis. Web.