What are the best eye drops for conjunctivitis in patients with a Cipro (ciprofloxacin) allergy?

From the Guidelines

For conjunctivitis with a ciprofloxacin allergy, the best eye drops would be non-fluoroquinolone antibiotics such as erythromycin ophthalmic ointment (0.5%) applied 2-4 times daily, or trimethoprim-polymyxin B drops (Polytrim) used 1-2 drops every 3-4 hours for bacterial conjunctivitis. For viral conjunctivitis, artificial tears used 4-6 times daily can provide symptomatic relief. If allergic conjunctivitis is suspected, antihistamine drops like ketotifen (Zaditor, Alaway) used twice daily or olopatadine (Pataday) once daily are effective options, as they have a dual action of antihistamine and mast cell stabilizer activities, making them suitable for acute and longer-term treatment of allergic conjunctivitis symptoms 1. It's essential to avoid all fluoroquinolone eye drops (including ofloxacin, levofloxacin, and moxifloxacin) due to potential cross-reactivity with your ciprofloxacin allergy. Warm compresses applied to closed eyelids for 5-10 minutes several times daily can help relieve symptoms regardless of cause. If symptoms worsen or don't improve within 2-3 days of treatment, consult an eye care professional as alternative treatments may be needed based on the specific type of conjunctivitis, and it is crucial to follow the recommended practice patterns for conjunctivitis to prevent complications and reduce the risk of transmission 1.

Some key points to consider in the management of conjunctivitis include:

• The use of topical antibiotics should be avoided in viral conjunctivitis, as they will not respond to antibacterial agents 1
• The use of topical corticosteroids should be reserved for severe symptoms of allergic conjunctivitis, as they can have vision-threatening side effects 1
• The importance of proper hygiene and prevention of transmission, especially in epidemic adenoviral conjunctivitis 1
• The need for a thorough review of systems to identify underlying systemic diseases that may be associated with conjunctivitis 1

From the FDA Drug Label

AzaSite ® is indicated for the treatment of bacterial conjunctivitis caused by susceptible isolates of the following microorganisms:

The recommended dosage regimen for the treatment of bacterial conjunctivitis is: Instill 1 drop in the affected eye(s) twice daily, eight to twelve hours apart for the first two days and then instill 1 drop in the affected eye(s) once daily for the next five days.

For a patient with a cipro allergy, azithromycin ophthalmic solution (AzaSite) may be considered as an alternative treatment for bacterial conjunctivitis.

• The patient should be advised to follow the recommended dosage regimen and administration instructions.
• It is essential to note that AzaSite is contraindicated in patients with hypersensitivity to any component of this product.
• Patients should be monitored for signs of anaphylaxis or other hypersensitivity reactions. 2

From the Research

Alternatives to Ciprofloxacin for Conjunctivitis

When considering alternatives to ciprofloxacin for the treatment of conjunctivitis due to a cipro allergy, several options are available:

• Azithromycin 1.5% eye drops have been shown to be effective in treating purulent bacterial conjunctivitis, with a convenient 3-day treatment regimen 3, 4.
• Tobramycin 0.3% eye drops are another option, although they may require a longer treatment duration 3, 5, 6, 4.
• Gentamycin eye drops may also be considered, as they have been mentioned as a preferred antibiotic for the treatment of acute bacterial conjunctivitis 5.

Key Considerations

When selecting an alternative to ciprofloxacin, it is essential to consider the following factors:

• The severity of the infection: Fluoroquinolones like ciprofloxacin are typically reserved for severe infections due to their broad spectrum of activity 5.
• The potential for antibiotic resistance: The development of resistance to antibiotics is a concern, and treatment decisions should be made with this in mind 5.
• Patient factors: The age and health status of the patient, as well as any potential allergies or sensitivities, should be taken into account when selecting a treatment option.

Available Evidence

The available evidence suggests that azithromycin 1.5% eye drops are a viable alternative to ciprofloxacin for the treatment of conjunctivitis, with a shorter treatment duration and similar efficacy to tobramycin 0.3% eye drops 3, 4. Tobramycin 0.3% eye drops and gentamycin eye drops may also be considered, although their use may be limited by factors such as treatment duration and potential resistance 5, 6.