What is the appropriate treatment with Augmentin (amoxicillin/clavulanate) for a 12-year-old female weighing 80 pounds with bacterial conjunctivitis?

Oral Augmentin is NOT Appropriate for Bacterial Conjunctivitis

Bacterial conjunctivitis requires topical antibiotic therapy, not oral antibiotics. Augmentin (amoxicillin-clavulanate) has no role in treating uncomplicated bacterial conjunctivitis in children. 1

Why Topical Antibiotics Are Required

• Topical antibiotics are the standard of care for bacterial conjunctivitis, as they deliver high concentrations directly to the infected conjunctival surface, reduce symptom duration by 2-3 days, decrease transmissibility, and allow earlier return to school. 1
• A 5-7 day course of broad-spectrum topical antibiotic accelerates clinical and microbiological remission and is recommended by the American Academy of Ophthalmology. 1
• The most common bacterial pathogens in pediatric conjunctivitis are Haemophilus influenzae (45%), Streptococcus pneumoniae (31%), and Staphylococcus aureus (8%), all of which respond to topical therapy. 2

Appropriate Topical Antibiotic Options for This Patient

For a 12-year-old with uncomplicated bacterial conjunctivitis, choose one of the following topical agents:

• Polymyxin B/trimethoprim drops (convenient, inexpensive, effective for common pathogens) 1
• Erythromycin 0.5% ointment (particularly useful at bedtime, well-tolerated in children) 1
• Tobramycin drops or ointment (broad-spectrum aminoglycoside) 1
• Fluoroquinolones (moxifloxacin, gatifloxacin, besifloxacin) should be reserved for moderate-to-severe cases with copious purulent discharge, marked inflammation, or suspected resistant organisms. 1

The American Academy of Ophthalmology recommends choosing the most convenient or least expensive topical antibiotic for mild cases, as no clinical evidence suggests superiority of any particular agent. 1

When Systemic Antibiotics ARE Indicated

Oral antibiotics are ONLY required for:

• Gonococcal conjunctivitis: Requires ceftriaxone 25-50 mg/kg IM (max 250 mg) as a single dose PLUS topical therapy. 3
• Chlamydial conjunctivitis: Requires azithromycin 1 g orally as a single dose (for children ≥8 years) or erythromycin 50 mg/kg/day divided into four doses for 14 days (for younger children). 3
• Both conditions require systemic therapy because more than 50% of infected children have infection at other anatomic sites. 4

Critical Red Flags Requiring Ophthalmology Referral

Refer immediately if any of the following are present:

• Visual loss or moderate-to-severe pain 4
• Severe purulent discharge suggesting gonococcal infection 4
• Corneal involvement (opacity, infiltrate, or ulceration) 4
• Conjunctival scarring or membrane formation 4
• No improvement after 3-4 days of appropriate topical therapy 1, 4
• History of herpes simplex virus eye disease 4
• Immunocompromised state 4

Special Consideration for This Patient

In a 12-year-old with conjunctivitis, consider sexual abuse if gonococcal or chlamydial infection is diagnosed. The American Academy of Pediatrics and American Academy of Ophthalmology recommend that sexual abuse must be considered in preadolescent children with sexually transmitted conjunctivitis, and appropriate reporting is mandatory. 3, 4

Treatment Algorithm

1. Confirm bacterial conjunctivitis clinically: Purulent discharge, mattering of eyelids on waking, lack of itching, and absence of prior conjunctivitis history suggest bacterial etiology. 5
2. Prescribe topical antibiotic (polymyxin B/trimethoprim, erythromycin, or tobramycin) for 5-7 days. 1
3. Advise return in 3-4 days if no improvement for re-evaluation and consideration of cultures. 1, 4
4. Do NOT prescribe oral Augmentin unless there is a concurrent systemic infection unrelated to the conjunctivitis. 1