A 13-day-old infant, referred to as B, presents for a well-newborn visit. The infant was born at 38 weeks via normal spontaneous vaginal delivery to a 27-year-old woman, G1P1. He had an uncomplicated newborn nursery course with routine newborn care and was discharged with his mother at age 2 days. The patient nurses for 15-20 minutes on each breast every 2 hours. He has approximately 7 wet diapers and 3 stools per day. Weight, length, and head circumference are at the 75th percentile. Vitals are normal.

On exam, the anterior fontanelle is open, soft, and flat. Pupils are equal and reactive to light. Both eyes have mild eyelid swelling, conjunctival injection, and a scant amount of watery, slightly mucopurulent discharge. Parents report that this discharge began 2 days ago. The rest of the exam is normal. A sample of the eye discharge is sent for analysis. Which of the following is the most appropriate treatment?

A. Oral azithromycin
B. Topical erythromycin
C. Topical silver nitrate

The most appropriate treatment for bacterial conjunctivitis in a 13-day-old infant with mild eyelid swelling, conjunctival injection, and a scant amount of watery, slightly mucopurulent discharge is topical erythromycin.

Explanation:

In this case, the 13-day-old infant is presenting with mild eyelid swelling, conjunctival injection, and a scant amount of watery, slightly mucopurulent discharge. These symptoms, along with the timing of the onset of discharge, suggest a possible bacterial infection.

The most appropriate treatment for bacterial conjunctivitis in infants is topical antibiotic ointment or drops. The options given are:

Oral AZ
Topical erythromycin
Topical silver nitrate

Oral AZ (azithromycin) is an oral antibiotic and is not the most appropriate treatment for this condition.

Topical silver nitrate is used for the prevention and treatment of ophthalmia neonatorum, which is a different condition characterized by eye infection in newborns. It is not the most appropriate treatment for bacterial conjunctivitis.

The most appropriate treatment for bacterial conjunctivitis in infants is topical erythromycin. Erythromycin is an antibiotic that is effective against the bacteria commonly responsible for this type of infection.

It is important to consult a healthcare professional for a proper diagnosis and treatment plan. They will be able to provide the appropriate prescription and instructions for the use of topical erythromycin.

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