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Polytrim useful first-line treatment for pediatric conjunctivitis
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This is the first article in a series that will spotlight specific ophthalmic medications. Polytrim is discussed because of its usefulness as a first-line antibiotic in primary care optometry. Each month a different drug from "My Top 15 Ophthalmic Medications" will be reviewed. I will explain when to prescribe these medications, the possible side effects and treatment plans based on a specific diagnosis.
--- Bobby Christensen, OD
Pinkeye in young children is viewed with great concern by teachers and parents. Prompt and appropriate treatment is essential to prevent the rapid spread of this infection through day care centers or school classrooms.
We sometimes forget to differentiate pediatric conjunctivitis from adult conjunctivitis. A high percentage of adult conjunctivitis is caused by Staphylococcus bacteria, while frequently pediatric conjunctivitis is caused by Hemophilus influenzae and Streptococcus pneumoniae.
Staphylococcus is usually susceptible to aminoglycosides such as gentamicin and tobramycin, but Streptococcus and Hemophilus are much more resistant to treatment with aminoglycosides. My treatment of choice for pediatric conjunctivitis is Polytrim (trimethoprim sulfate, polymyxin B sulfate, Allergan). Adults who have contracted the infection from their children or students should also be treated with Polytrim.
Gentle, but effective
Polytrim is gentle to the corneal epithelium and effective against most Streptococcus and Hemophilusstrains, as well as Staphylococcus. It contains two components: trimethoprim sulfate and polymyxin B.
Trimethoprim sulfate is effective against both gram-positive and gram-negative bacteria. Poly myxin B is effective against many gram-negative organisms. This combination drug is preserved with 0.004% benzalkonium chloride. A low concentration of preservative combined with antibiotic components that are easy on the eye make this medication an excellent choice for pediatric conjunctivitis.
Polytrim is also appropriately used as a prophylactic after abrasions, foreign body removal or before insertion of punctal plugs for patients of all ages.
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Scrub lids first
Lid scrubs and saline rinse should be used to remove mucopurulent discharge before the drops are instilled. This will enhance the effectiveness of the antibiotic, because it removes bacteria and toxins from the eye. Also, there is evidence that the para-aminobenzoic acid (PABA) in the mucus competes with Polytrim, reducing its effectiveness. My philosophy has been to have patients scrub their lids and rinse their eyes when treating any bacterial or viral infection to enhance the effectiveness of the medication.
A patient history of allergic reaction to sulfa drugs should not exclude Polytrim as a treatment. There seems to be no correlation between trimethoprim sulfate and sulfa sensitivity. After using Polytrim for many years, I have not witnessed any reactions in patients with sulfa hypersensitivity.
Treatment plan
When using Polytrim solution (10 mL-bottle):
- Use a warm washcloth and baby shampoo to scrub the lids.
- Use 10 to 20 drops of saline to rinse eye(s) before Polytrim instillation.
- Instill a drop of Polytrim in affected eye(s) four times daily for 6 days. (Teach the patient or parent how to instill the drops.)
Treatment caveats
Observe the following hygiene precautions: Wash hands thoroughly with soap and water after touching the eye or instilling medication. Use only clean or single-use, disposable towels to dry the face and hands. Be sure others do not use the towel or washcloth. Wash these articles in detergent and hot water. Change pillow cases daily.
To avoid transmission of infection, do not return to school or work until the eye no longer produces matter and most of the injection has cleared (typically 2 to 3 days).
Polytrim is an effective antibiotic for pediatric bacterial conjunctivitis with low to moderate mucopurulent discharge. Conjunctivitis causing large amounts of mucopurulent discharge should be treated with other antibiotics that are not as susceptible to the effects of PABA.
For Your Information:
- Bobby Christensen, OD, is in private practice in Midwest City, Okla. He lectures widely on therapeutic pharmaceutical agents. He can be contacted at Heritage Park Medical Center, 6912 E. Reno, Suite 101, Midwest City, OK 73110; (405) 732-2277; fax: (405) 737-4776. Dr. Christensen has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.