Case 1: Nix (permethrin lotion, 1%) is an appropriate product for KP. According to the Centers for Disease Control and Prevention, Nix and RID (pyrethrum extract [equivalent to 0.33% pyrethrins]/piperonyl butoxide 4%; Bayer HealthCare LLC) are both appropriate first-line OTC agents for lice eradication. Nix is approved for children 2 months and older, while RID is approved for children 2 years and older. Although both products kill live lice, neither kills unhatched eggs; therefore, it is not uncommon for a second application to be required about 10 days later (to kill newly hatched lice). The pharmacist should inform the mother that KP’s long hair will likely require 2 bottles per treatment. Additionally, KP’s mother should be told that conditioner should not be used prior to Nix and that KP’s hair should not be washed for 1 or 2 days after application (permethrin has a residual effect after application, and conditioner may disrupt adherence of permethrin to the hair shaft). Treatment should stop after 2 applications and when no eggs or lice are found after combing.
Case 2: JD is likely suffering from conjunctivitis, which can be due to bacterial, viral, or allergic causes. The signs and symptoms can help to determine the root cause. In JD’s case, his physical presentation of purulent discharge, crusting around the eyelid, and swelling are suggestive of acute bacterial conjunctivitis (viral conjunctivitis is typically associated with prominent blood vessels in the eye, watery discharge, and abnormal lymph nodes; allergic conjunctivitis is typically associated with itchy red eyes, lid edema, string-like discharge, and comorbid allergenic rhinitis).
Because JD is likely suffering from acute bacterial conjunctivitis, Visine-A (naphazoline hydrochloride 0.025% as a redness reducer; pheniramine maleate 0.3% as an antihistamine) is not an appropriate treatment option. Referral to his physician is necessary to obtain a broad-spectrum ophthalmic antibiotic such as levofloxacin 0.5% solution to treat the most likely pathogens (Staphylococcus aureus, Haemophilus influenzae, Staphylococcus pneumoniae, or gram-negative bacteria).