What oral antibiotic is recommended for a patient with bilateral conjunctivitis and hordeolum?

From the Guidelines

For a patient with bilateral conjunctivitis and hordeolum, the oral antibiotic of choice is Azithromycin 1 g orally, single dose, due to its efficacy against common causative organisms such as Chlamydia, as recommended by the 2024 conjunctivitis preferred practice pattern 1. When considering the treatment of bilateral conjunctivitis and hordeolum, it's crucial to identify the underlying cause to guide antibiotic selection.

• The most common causes of conjunctivitis include viral, bacterial, and chlamydial infections.
• Hordeolum, or stye, is typically caused by Staphylococcus aureus. Given the potential for Chlamydia as a cause of conjunctivitis, Azithromycin is a preferred choice due to its broad-spectrum activity and single-dose regimen, which enhances patient compliance.
• According to the 2024 guidelines 1, Azithromycin 1 g orally, single dose, is recommended for Chlamydia, making it a suitable option for patients with bilateral conjunctivitis and hordeolum when an oral antibiotic is deemed necessary. It's essential to note that not all cases of conjunctivitis and hordeolum require oral antibiotics; many can be managed with topical treatments and supportive care.
• However, in cases where oral antibiotics are necessary, Azithromycin 1 g orally, single dose, offers a convenient and effective treatment option, as supported by the latest guidelines 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Oral Antibiotic Choice for Bilateral Conjunctivitis and Hordeolum

• The choice of oral antibiotic for a patient with bilateral conjunctivitis and hordeolum depends on the underlying cause of the infection.
• According to a study published in the Journal of Pediatric Ophthalmology and Strabismus 2, long-term, low-dose oral azithromycin treatment can be effective in treating chronic severe bilateral blepharokeratoconjunctivitis in pediatric patients.
• Another study published in the Japanese Journal of Ophthalmology 3 found that azithromycin hydrate ophthalmic solution is effective in treating internal hordeolum and meibomitis.
• However, it's worth noting that not all cases of conjunctivitis require antibiotic treatment. A study published in The Cochrane Database of Systematic Reviews 4 found that topical antibiotics can improve clinical cure rates in acute bacterial conjunctivitis, but the benefits may be modest.
• A review article published in the American Family Physician 5 recommends supportive care options for viral conjunctivitis, including artificial tears, cold compresses, and antihistamine eye drops, and topical antihistamines with mast cell-stabilizing activity for allergic conjunctivitis.
• For bacterial conjunctivitis, delayed antibiotic prescribing has been found to have similar symptom control as immediate prescribing, and ophthalmology referral is indicated for certain high-risk patients 5.
• A systematic review published in JAMA 6 found that conjunctivitis caused by sexually transmitted diseases such as chlamydia and gonorrhea requires systemic treatment in addition to topical antibiotic therapy.

Key Considerations

• The diagnosis and management of conjunctivitis should be guided by a comprehensive history and physical examination.
• The choice of oral antibiotic should be based on the underlying cause of the infection and the patient's individual needs.
• Topical antibiotics and supportive care options may be effective in treating certain types of conjunctivitis, and oral antibiotics may be reserved for more severe or complicated cases 4, 2, 5.