What is the treatment for bacterial conjunctivitis?

From the Guidelines

Bacterial conjunctivitis should be treated with topical antibiotics, regardless of the severity of symptoms, as they reduce the duration of symptoms and may reduce transmissibility. The choice of antibiotic is usually empiric, and a 5- to 7-day course of a broad-spectrum topical antibiotic is usually effective 1.

Treatment Options

• Topical antibiotic eye drops or ointments, such as erythromycin ophthalmic ointment (0.5%) or fluoroquinolone drops like moxifloxacin 0.5% or ciprofloxacin 0.3%, can be used to treat bacterial conjunctivitis 1.
• For contact lens wearers, fluoroquinolones are preferred due to their coverage against Pseudomonas.
• Treatment should continue for 5-7 days, even if symptoms improve earlier.

Additional Considerations

• Patients should temporarily discontinue contact lens use until the infection resolves completely.
• Good hygiene practices are essential during treatment, including frequent handwashing, avoiding touching or rubbing the eyes, using separate towels and pillowcases, and discarding eye makeup that may be contaminated.
• Most bacterial conjunctivitis is self-limiting and will resolve within 7-14 days even without treatment, but antibiotics can speed recovery, reduce symptom duration, and prevent spread to others by targeting the causative bacteria and reducing the bacterial load in the eye 1.

Special Cases

• In cases where access to antibiotics is limited, povidone-iodine 1.25% ophthalmic solution may be considered as an alternative treatment option 1.

From the FDA Drug Label

Gatifloxacin ophthalmic solution, 0.5% is indicated for the treatment of bacterial conjunctivitis caused by susceptible strains of the following organisms: Aerobic Gram-Positive Bacteria: Staphylococcus aureus Staphylococcus epidermidis Streptococcus mitis group* Streptococcus oralis* Streptococcus pneumoniae Aerobic Gram-Negative Bacteria: Haemophilus influenzae Patients 1 year of age or older: Instill one drop every two hours in the affected eye(s) while awake, up to 8 times on Day 1. Instill one drop two to four times daily in the affected eye(s) while awake on Days 2 through 7.

The treatment for bacterial conjunctivitis with gatifloxacin ophthalmic solution, 0.5% is:

• Instillation: one drop every two hours in the affected eye(s) while awake, up to 8 times on Day 1
• Dosage: one drop two to four times daily in the affected eye(s) while awake on Days 2 through 7
• Target organisms:
  • Aerobic Gram-Positive Bacteria: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus mitis group, Streptococcus oralis, Streptococcus pneumoniae
  • Aerobic Gram-Negative Bacteria: Haemophilus influenzae 2

From the Research

Treatment for Bacterial Conjunctivitis

• Bacterial conjunctivitis can be treated with topical antibiotics, which have been shown to decrease the duration of the infection and allow for an earlier return to school or work 3, 4.
• Topical moxifloxacin, a fourth-generation fluoroquinolone, has been found to be effective in treating bacterial conjunctivitis, with a higher potency and faster in vitro "speed-to-kill" compared to other antibiotics 5, 6, 7.
• Moxifloxacin has been shown to penetrate better into ocular tissues than other fluoroquinolones and has better mutant prevention characteristics, making it a good option for the treatment of bacterial conjunctivitis 5, 6.
• The use of topical moxifloxacin can be cost-effective and may generate total healthcare budget savings by reducing the costs of managing treatment failures and the use of clinicians' time to manage such failures 6.
• Other antibiotics, such as tobramycin and gentamicin, may not be as effective as moxifloxacin in killing bacterial conjunctivitis isolates, and may even promote bacterial growth 7.

Comparison of Antibiotics

• Moxifloxacin has been compared to other antibiotics, such as tobramycin and gentamicin, and has been found to have a faster kill rate and higher potency 7.
• The use of moxifloxacin has been found to be associated with modestly improved rates of clinical and microbiological remission compared to placebo 4.
• Topical antibiotics, including moxifloxacin, have been found to be of benefit in improving early clinical and microbiological remission rates, and may still confer modest benefits in clinical remission and microbiological cure rates at later time points 4.

Clinical Implications

• The use of topical moxifloxacin can be considered as a first-line treatment for bacterial conjunctivitis to minimize patient symptoms and to limit the contagiousness of the disease 6, 7.
• Clinicians should consider the use of topical antibiotics, such as moxifloxacin, in the treatment of bacterial conjunctivitis, especially in cases where the infection is severe or persistent 3, 4.