From the Guidelines
For a 56-year-old male with bilateral bacterial conjunctivitis not responding to ofloxacin, I recommend oral azithromycin 500 mg once daily for 3 days. This recommendation is based on the most recent guidelines from the World Health Organization's essential medicines and awareness recommendations on first- and second-choice antibiotics for empiric treatment of clinical infections 1. Although the study does not specifically address the use of oral antibiotics for conjunctivitis, it mentions that for trachoma, single-dose oral azithromycin is recommended, which can be extrapolated to other bacterial conjunctivitis cases. Some key points to consider when treating this patient include:
- Obtaining a conjunctival culture to identify the specific pathogen and its antibiotic sensitivities before starting oral antibiotics
- Continuing good eye hygiene by gently cleaning away discharge with warm water, avoiding eye rubbing, using separate towels, and washing hands frequently
- Monitoring for improvement within 48-72 hours of oral therapy and referring to an ophthalmologist if symptoms persist
- Being aware that treatment failure with topical fluoroquinolones may indicate resistant organisms like MRSA or Pseudomonas, which may require alternative antibiotic therapy.
From the FDA Drug Label
Azithromycin binds to the 23S rRNA of the bacterial 50S ribosomal subunit. It blocks protein synthesis by inhibiting the transpeptidation/translocation step of protein synthesis and by inhibiting the assembly of the 50S ribosomal subunit.
The FDA drug label does not answer the question.
From the Research
Treatment Options for Bacterial Conjunctivitis
- The patient has bilateral conjunctivitis with discharges that are not improving with ofloxacin, indicating a need for an alternative treatment approach 2.
- For cases of bacterial conjunctivitis that do not respond to topical antibiotics, systemic antibiotics may be considered, especially if the infection is caused by gonococcal or chlamydial organisms 2.
- Azithromycin has been shown to be effective in treating chlamydial conjunctivitis, with a single 1-g dose being as effective as a 10-day course of doxycycline 3.
- Doxycycline is another option for treating bacterial conjunctivitis, particularly for cases caused by chlamydial infections 3, 4.
Oral Medication Options
- Azithromycin is an oral antibiotic that can be used to treat bacterial conjunctivitis, particularly for cases caused by chlamydial infections 3.
- Doxycycline is another oral antibiotic that can be used to treat bacterial conjunctivitis, especially for cases caused by chlamydial infections 3, 4.
- The choice of oral antibiotic should be based on the suspected causative organism and the patient's medical history, as well as the potential for antibiotic resistance 5, 6.