From the Guidelines
Mild bacterial conjunctivitis can be effectively managed without specific treatment in immune-competent adults, but topical antibacterial therapy can lead to earlier clinical and microbiological remission. When considering treatment, the choice of antibiotic is usually empiric, and a 5- to 7-day course of a broad-spectrum topical antibiotic is usually effective 1. Some key points to consider when treating bacterial conjunctivitis include:
- The most convenient or least expensive antibiotic option can be selected, as there is no clinical evidence suggesting the superiority of any particular antibiotic 1
- Povidone-iodine 1.25% ophthalmic solution may be as effective as topical antibiotic therapy for treating bacterial conjunctivitis and could be considered when access to antibiotics is limited 1
- Treatment may reduce transmissibility and allow for an earlier return to school for children
- It is essential to complete the full course of treatment even if symptoms improve quickly to ensure the infection is fully cleared
- While using eye medications, it is crucial to avoid touching the dropper tip to any surface, including the eye, to prevent contamination, and to wash hands thoroughly before and after application 1. In terms of specific treatment regimens, broad-spectrum antibiotics like erythromycin ointment, polymyxin B-trimethoprim drops, or fluoroquinolones such as ciprofloxacin or moxifloxacin can be used, with application frequencies similar to those described in the example answer. However, the decision to treat mild bacterial conjunctivitis should be individualized, considering the potential benefits of shortened morbidity associated with antibiotic use 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:
- Corynebacterium species*
- Micrococcus luteus*
- Staphylococcus aureus
- Staphylococcus epidermidis
- Staphylococcus haemolyticus
- Staphylococcus hominis
- Staphylococcus warneri*
- Streptococcus pneumoniae
- Streptococcus viridans group
- Acinetobacter lwoffii*
- Haemophilus influenza
- Haemophilus parainfluenzae*
- Chlamydia trachomatis
Instill one drop in the affected eye 3 times a day for 7 days.
Treating bacterial conjunctivitis can be done with moxifloxacin ophthalmic solution. The recommended dosage is one drop in the affected eye, three times a day, for 7 days 2.
AzaSite ® is indicated for the treatment of bacterial conjunctivitis caused by susceptible isolates of the following microorganisms:
- CDC coryneform group G
- Haemophilus influenzae
- Staphylococcus aureus
- Streptococcus mitis group
- Streptococcus pneumoniae
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
- Then instill 1 drop in the affected eye(s) once daily for the next five days.
Azithromycin ophthalmic solution can also be used to treat bacterial conjunctivitis. The recommended dosage is one drop in the affected eye, twice daily for the first two days, and then once daily for the next five days 3.
- Key points:
- Moxifloxacin and azithromycin are both effective for treating bacterial conjunctivitis.
- Dosage and administration instructions should be followed carefully to ensure effective treatment and minimize the risk of resistance or side effects.
From the Research
Treatment Options for Bacterial Conjunctivitis
- Topical antibiotics, such as polymyxin B sulfate/trimethoprim and moxifloxacin, have been shown to be effective in treating bacterial conjunctivitis 4
- Moxifloxacin has been found to be more effective and faster in resolving symptoms compared to polymyxin B sulfate/trimethoprim 4
- Fluoroquinolones, such as moxifloxacin, have good activity in treating acute bacterial conjunctivitis, but should be reserved for severe infections due to their broad spectrum of activity 5
Antibiotic Therapy
- Antibiotic therapy has been shown to improve clinical and microbiological remission rates in acute bacterial conjunctivitis 6, 7
- Topical antibiotics have been found to be associated with modestly improved rates of clinical and microbiological remission compared to placebo 6, 7
- The use of antibiotic eye drops can speed the resolution of symptoms and infection, and may be considered to achieve better clinical and microbiologic efficacy than placebo 6, 7
Considerations for Treatment
- The development of resistance to antibiotics is a concern, and the use of topical fluoroquinolones, such as moxifloxacin, may help to reduce the risk of resistance 8
- Topical moxifloxacin has been shown to have a higher potency and faster in vitro "speed-to-kill" compared to other antibiotics, and may be a cost-effective option for treating bacterial conjunctivitis 8
- The use of topical moxifloxacin may also reduce the number of treatment failures and the associated healthcare costs 8