From the Guidelines
For moderate to severe bacterial conjunctivitis, including cases caused by Methicillin-resistant Staphylococcus aureus (MRSA), treatment should be guided by laboratory tests, and may include compounded topical antibiotics such as vancomycin, as well as systemic antibiotic therapy in certain cases. The choice of antibiotic is crucial in managing bacterial conjunctivitis, especially with the increasing incidence of MRSA 1. When gonococcal infection is a possibility, conjunctival cultures and slides for Gram staining should be obtained to guide antibiotic selection 1.
Key considerations in managing bacterial conjunctivitis include:
- Obtaining laboratory tests to guide therapy, especially in cases of suspected MRSA or gonococcal infection 1
- Using systemic antibiotic therapy for infections caused by Neisseria gonorrhoeae and Chlamydia trachomatis 1
- Considering initiation of systemic therapy prior to obtaining culture results when there is high clinical suspicion 1
- Using topical therapy, such as compounded antibiotics, in addition to systemic therapy when necessary 1
It is essential to prioritize the use of the most recent and highest quality evidence in guiding treatment decisions for bacterial conjunctivitis, to minimize morbidity, mortality, and improve quality of life 1.
From the FDA Drug Label
Moxifloxacin ophthalmic solution, 0. 5% is indicated for the treatment of bacterial conjunctivitis caused by susceptible strains of the following organisms: *Efficacy for this organism was studied in fewer than 10 infections.
Besivance™ (besifloxacin ophthalmic suspension) 0. 6%, is indicated for the treatment of bacterial conjunctivitis caused by susceptible isolates of the following bacteria: *Efficacy for this organism was studied in fewer than 10 infections.
The FDA drug label does not answer the question about MCC bacterial conjunctivitis. 2 3
From the Research
Mcc Bacterial Conjunctivitis
- Bacterial conjunctivitis is a common health-care issue, with signs and symptoms usually allowing a correct diagnosis without conjunctival swab 4.
- The most prevalent species causing bacterial conjunctivitis are Haemophilus influenzae, Staphylococcus epidermidis, Staphylococcus aureus, the Streptococcus mitis group, and Streptococcus pneumoniae 5.
- Methicillin-resistant Staphylococcus aureus (MRSA) strains have been isolated with increasing frequency in the last few years, and the development of resistance of typical germs to all antibiotic groups is alarming 4, 6.
- Topical antibiotics such as azithromycin or fluoroquinolones are usually prescribed for the treatment of bacterial conjunctivitis, but the use of fluoroquinolones should be reserved for severe infections due to their broad spectrum of activity 4, 7.
- In cases of gonococcal and chlamydial conjunctivitis, systemic antibiotics are warranted due to their potential for severe complications 7, 8.
- Preventive measures, including maternal screening and treatment, are crucial public health initiatives to curb the risks associated with bacterial conjunctivitis 7.
Treatment and Management
- Topical antibiotics decrease the duration of bacterial conjunctivitis and allow earlier return to school or work 8.
- Conjunctivitis secondary to sexually transmitted diseases such as chlamydia and gonorrhea requires systemic treatment in addition to topical antibiotic therapy 8.
- The majority of cases in bacterial conjunctivitis are self-limiting, and no treatment is necessary in uncomplicated cases 8.
- However, conjunctivitis caused by gonorrhea or chlamydia and conjunctivitis in contact lens wearers should be treated with antibiotics 8.
Complications and Risk Factors
- Bacterial conjunctivitis can lead to complications like corneal scarring and systemic infections in high-risk groups, including newborns and immunocompromised patients 7.
- Increasing antibiotic resistance might even necessitate tailored therapy based on antibiotic susceptibility profiles 7.
- MRSA-associated conjunctivitis is notable for its occurrence in patients with severe neurologic disease, and both oral ciprofloxacin and topical vancomycin therapy were associated with clinical resolution 6.