A Pediatrician’s Dirty Little Secrets - Part 4
Robert P. Lindeman, MD, PhD
Natick Pediatrics, PC

This is the fourth in a series of articles that reveal what I refer to as ‘dirty little secrets’ about pediatrics in today’s world. The title is a joke, of course: there is neither anything dirty nor secret about the stories. I refer to them as secrets because if these stories circulated widely throughout the community and if enough parents believed the stories to be true, primary care pediatrics as we know it would vanish quickly. Most pediatricians don’t want to vanish quickly. That’s why these stories remain secret, until now that is.

Secret #4 – A Home Remedy for Pink Eye

A few years ago I came across a package insert that came with prescription-strength Neosporin-brand ophthalmic (eye) ointment. I usually don’t read package inserts, but on a whim I decided to read the ingredients. I’m glad I did. My whim led me on a journey that ends with my treating acute bacterial conjunctivitis ("pink eye") very differently than I used to.

The ingredients list for prescription-strength Neosporin reads as follows:
Neomycin sulfate, polymyxin B sulfate, bacitracin zinc, and white petrolatum.

"That’s it?" I said to myself. This ingredients list looked vaguely familiar. I quickly looked up the list of ingredients in over-the-counter (OTC) triple antibiotic ointment. The list of ingredients read:
Neomycin sulfate, polymyxin B sulfate, bacitracin zinc, and white petrolatum.

And the amounts of medication were also exactly the same as the prescription product! But the labeling on the OTC ointment warns against placing the product in the eye. Pharmacists will tell you the same thing. Why is that?

The package inserts give no hint as to what makes the prescription product suitable for placement in the eye, and the other unsuitable. One can only guess. One possibility is that the "prescription strength" product is produced under much more sterile conditions than the OTC product. This makes sense until you consider that what we are discussing here is a mixture of three antibiotics. What, exactly is this stuff going to become contaminated with, other bacteria? Fungus? And if so, isn’t the prescription-strength product susceptible to contamination as well?

The directions on the prescription medication instruct the patient to wash his hands well before using, and to be careful not to touch the tube of medicine with anything other than the finger onto which he is going to place the dab of medicine. The reason for this is to avoid contaminating the ointment with any other bacteria that might be resistant to neomycin, polymixin, AND bacitracin. That sounds reasonable enough: why not do the same with a fresh tube of OTC triple antibiotic ointment?

Still, I wasn’t convinced that the OTC ointment was okay for use in the eyes, so I went to the internet, and asked one of my colleagues at a password-protected physician’s discussion group. I found an ophthalmologist, in practice for 40 years, who told me to go ahead, there was no problem with the OTC medication.

Now I was ready to begin recommending OTC triple antibiotic ointment to my patients with apparent bacterial conjunctivitis. To my surprise and delight, every child tolerated the treatment very well, and my "cure rate" was just as good as it had been with prescription ointments. I have been making this recommendation privately, over the phone or in the office, for three years. Now it’s time to reveal this dirty little secret to the rest of the world!

I decide that a child needs antibiotics for conjunctivitis based on how much pus there is pouring out of the eye. A typical story will go like this: the child has had a cold for a few days. Now, when she wakes up, she can’t open her eyes because her eyelashes are stuck closed with pus!

I recommend that you call your doctor if you suspect bacterial conjunctivitis. There are many causes of pink eyes, and only one of them gets better with triple antibiotic ointment, bacterial infections. There are also viral infections, allergic reactions, and reactions to objects getting stuck in the eye, or simply being poked in the eye! Talk to your child’s doctor about the circumstances leading to the child having red or swollen eyes.

There are some eye infections that require more than just OTC triple antibiotic ointment. If a mother with active Chlamydia or Gonorrhea (both sexually-transmitted diseases) gives birth to a baby, she could pass these infections to her baby, and the infection could cause conjunctivitis. If you or the baby’s doctor suspects that you have either one of these diseases, the baby needs to be seen by a doctor.