Polytrim for Bacterial Conjunctivitis in a 13-Year-Old
Yes, Polytrim (polymyxin B sulfate and trimethoprim sulfate ophthalmic solution) is appropriate and effective for treating bacterial conjunctivitis in a 13-year-old with presumed pink eye. 1
FDA-Approved Indication and Age Appropriateness
Polytrim is FDA-approved for treating surface ocular bacterial infections, including acute bacterial conjunctivitis, caused by susceptible organisms including Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa. 1
There is no age restriction in the FDA labeling, and the medication has been extensively studied and proven safe and effective in pediatric populations, including children as young as 1 month old. 1, 2, 3
Treatment Regimen
Instill 1 drop in the affected eye(s) every 3 hours (maximum 6 doses per day) for 7-10 days. 1
Clinical improvement should be evident within 3-5 days, with 62% of pediatric patients showing clinical cure by this timepoint in clinical trials. 3
Advise the patient to return if no improvement occurs after 3-4 days, as this may indicate resistant organisms, viral etiology, or other complications requiring further evaluation. 4
Evidence Supporting Use in Adolescents
Polytrim demonstrated 95% cure or improvement rates within 7 days in a large pediatric survey of 472 children with acute bacterial conjunctivitis, with physicians rating overall efficacy as excellent or good in 96% of cases. 2
Comparative trials show Polytrim is equally effective to gentamicin and superior to chloramphenicol for bacterial conjunctivitis in children, with clinical cure rates of 84-91% by 8-10 days. 5, 6
The medication enhances bacterial eradication (71% by days 3-5,79% by days 8-10) compared to placebo, shortening the duration of clinical disease. 3
Critical Safety Considerations and Red Flags
Before prescribing Polytrim, you must rule out conditions requiring different management:
Examine the cornea with fluorescein staining to detect corneal involvement, which would require more aggressive therapy. 7
If copious purulent discharge, severe pain, or marked inflammation is present, obtain conjunctival cultures and Gram stain to rule out gonococcal conjunctivitis, which requires systemic antibiotics (ceftriaxone 125 mg IM plus azithromycin 1 g PO). 4
Consider sexual abuse in any adolescent with gonococcal or chlamydial conjunctivitis, as these are sexually transmitted infections. 4
Polytrim is NOT indicated for viral conjunctivitis (which is self-limited and does not respond to antibiotics) or for ophthalmia neonatorum. 1
Patient Counseling Points
Avoid contaminating the dropper tip with material from the eye, fingers, or other sources to maintain sterility. 1
Do not wear contact lenses during treatment if signs and symptoms of bacterial infection are present. 1
Practice strict hand hygiene to prevent transmission to others or the unaffected eye, and avoid sharing towels. 8
Discontinue use and contact physician immediately if redness, irritation, swelling, or pain persists or increases. 1
Common Pitfalls to Avoid
Do not use Polytrim for prophylaxis or for treating ophthalmia neonatorum, as it is contraindicated for these indications. 1
Do not prescribe topical antibiotics alone for gonococcal or chlamydial conjunctivitis—these require systemic therapy. 4
Prolonged use may result in overgrowth of nonsusceptible organisms including fungi; if superinfection occurs, discontinue and initiate appropriate therapy. 1
Polytrim contains benzalkonium chloride preservative, which can cause additional irritation with frequent use; consider preservative-free alternatives if needed for extended therapy. 1
When to Refer to Ophthalmology
Immediate referral is warranted for: