What is the best treatment for a 67-year-old patient with an infected hordeolum (stye) presenting with redness, swelling, and a pustule, including recommended antibiotics?

From the Guidelines

The best treatment for a 67-year-old patient with an infected hordeolum (stye) includes warm compresses applied to the affected eye for 10-15 minutes, 4-6 times daily, combined with topical antibiotic therapy, such as erythromycin ophthalmic ointment 0.5% applied to the lid margin 3-4 times daily for 7-10 days. For more severe infections, oral antibiotics may be necessary, with dicloxacillin 250-500 mg four times daily or cephalexin 500 mg four times daily for 7-10 days being appropriate choices, as suggested by guidelines for the treatment of skin and soft tissue infections 1. If the patient has a pustule that is pointing, gentle drainage by an ophthalmologist may provide relief, but patients should never attempt to squeeze or drain the stye themselves. Good eyelid hygiene should be maintained by gently cleaning the eyelid margins with diluted baby shampoo. The warm compresses help to increase blood circulation to the area, promoting drainage and resolution of the infection, while antibiotics target the causative bacteria, typically Staphylococcus species. For this 67-year-old patient, it's essential to monitor for complete resolution of the infection and consider diabetes screening, as recurrent hordeola can be associated with diabetes mellitus, especially in older adults. Key considerations in managing skin and soft tissue infections, including hordeolum, involve assessing the need for antibiotic therapy based on the severity and extent of the infection, as well as the patient's overall health status, as outlined in guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections 1. Given the patient's age and the presence of a pustule, careful evaluation and possibly empirical therapy for CA-MRSA should be considered, with options including clindamycin, trimethoprim-sulfamethoxazole, or a tetracycline, pending culture results 1.

From the FDA Drug Label

Adults: The usual dose of oral doxycycline is 200 mg on the first day of treatment (administered 100 mg every 12 hours) followed by a maintenance dose of 100 mg/day

• The best treatment for a 67-year-old patient with an infected hordeolum (stye) presenting with redness, swelling, and a pustule is not explicitly stated in the provided drug labels.
• However, doxycycline 2 can be used to treat various bacterial infections, but its use for a hordeolum is not directly mentioned.
• Bacitracin 3 is a topical antibiotic ointment that can be used for minor cuts and scrapes, but its effectiveness for treating an infected hordeolum is not specified.
• Given the lack of direct information, it is recommended to consult a healthcare professional for proper diagnosis and treatment of the infected hordeolum.

From the Research

Treatment for Infected Hordeolum

• The treatment for an infected hordeolum (stye) typically involves relieving symptoms and promoting healing, but there is limited evidence on the effectiveness of specific interventions 4, 5, 6.
• A study published in 2022 found that the addition of an antibiotic to conservative measures for a hordeolum was not associated with an increased likelihood of treatment success 7.
• The same study found that older age was associated with a higher risk of receiving an antibiotic for a hordeolum, but this did not necessarily improve outcomes 7.

Antibiotic Use

• There is no clear evidence to support the use of antibiotics for treating hordeolum, and their use may not improve treatment outcomes 7.
• Antibiotics may be prescribed in certain cases, such as in emergency or acute care settings, but their effectiveness is unclear 7.
• The use of antibiotics for hordeolum should be carefully considered, taking into account the potential risks and benefits, as well as the limited evidence supporting their effectiveness 7.

Non-Surgical Interventions

• Non-surgical interventions, such as hot or warm compresses, lid scrubs, and steroids, may be used to treat hordeolum, but there is limited evidence on their effectiveness 4, 5, 6.
• Controlled clinical trials are needed to determine which interventions are effective for treating acute internal hordeolum 4, 5, 6.