What is the treatment for a 66-year-old male with a left eye infection and nasal squeeze-induced drainage?

From the Guidelines

The patient's symptoms suggest acute sinusitis, and given the recent drainage and improvement, it is likely a viral cause, so antibiotics like Moxifloxacin may not be necessary, and a follow-up appointment in two weeks is reasonable to assess for any worsening or improvement. The patient's report of drainage from the left eye after squeezing his nose at left eye level, which caused some relief, indicates a possible connection between the nasolacrimal duct and the infection. According to the clinical practice guideline update on adult sinusitis 1, acute viral sinusitis is likely if the patient has been sick for less than 10 days and is not getting worse. The patient denies any visual changes or discomfort, which suggests that the infection may not be severe.

The guideline also states that radiographic imaging of the paranasal sinuses is unnecessary for diagnosis in patients who already meet clinical diagnostic criteria for acute bacterial rhinosinusitis (ABRS) 1. Since the patient's symptoms are improving, and there are no signs of complications such as severe headache, facial swelling, or proptosis, imaging studies may not be necessary at this time.

The treatment with Moxifloxacin eye drops for 10 days may be premature, as the patient's symptoms may be due to a viral cause, and antibiotics would not be effective in this case 1. However, if the patient's symptoms worsen or do not improve within 10 days, antibiotic treatment may be reconsidered. The follow-up appointment in two weeks will allow for reassessment of the patient's condition and adjustment of the treatment plan as needed.

Key points to consider in the patient's treatment plan include:

• Monitoring for signs of worsening infection, such as increased pain, swelling, or discharge
• Assessing for any changes in vision or discomfort
• Reevaluating the need for antibiotic treatment if the patient's symptoms do not improve or worsen
• Providing patient education on proper hygiene and use of any prescribed medications, such as washing hands before application and avoiding touching the dropper tip to any surface.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Instill one drop in the affected eye 3 times a day for 7 days. ( 2) You are planning to prescribe Moxifloxacin eye drops for 10 days, but the recommended dosage is for 7 days 2. It is recommended to follow the dosage instructions as indicated in the drug label.

From the Research

Patient Presentation and Treatment

• The patient is a 66-year-old male presenting with a left eye infection, which he believes was caused by squeezing his nose at eye level, resulting in drainage.
• The patient reports feeling better after the drainage and denies any visual changes or discomfort.
• The patient has been prescribed Moxifloxacin eye drops for 10 days and is scheduled for a follow-up appointment in two weeks.

Rationale for Moxifloxacin Prescription

• Moxifloxacin is a fluoroquinolone antibacterial with a broad spectrum of activity, including against penicillin-resistant Streptococcus pneumoniae 3.
• Topical moxifloxacin has been shown to be effective in the treatment of bacterial conjunctivitis, with a higher potency and faster in vitro "speed-to-kill" compared to non-fluoroquinolones 4.
• The use of topical moxifloxacin can increase therapeutic effectiveness, reduce treatment failures, and be cost-effective in the treatment of bacterial conjunctivitis 4.

Safety and Efficacy of Moxifloxacin

• Moxifloxacin has been shown to be well-tolerated and effective in the treatment of various bacterial infections, including acute bacterial sinusitis, acute bacterial exacerbations of chronic bronchitis, and community-acquired pneumonia 3, 5.
• The most commonly reported adverse effects of moxifloxacin are gastrointestinal, such as nausea and diarrhea, and are typically mild to moderate in severity 5.

Relevance to Patient Presentation

• While the patient's symptoms are consistent with a bacterial conjunctivitis, there is no direct evidence in the provided studies to support the use of moxifloxacin in this specific patient population.
• However, the studies do provide evidence for the efficacy and safety of moxifloxacin in the treatment of bacterial infections, including those of the eye 4.