What is the antibiotic treatment for corneal abrasions?

From the Guidelines

Antibiotic treatment for corneal abrasions typically involves topical antibiotics to prevent infection while the cornea heals, with the first-line treatment being erythromycin 0.5% ointment or polymyxin B/trimethoprim drops applied 4 times daily for 3-5 days, as recommended by recent guidelines 1. The choice of antibiotic should be guided by local knowledge of antimicrobial resistance patterns, which vary widely in different countries.

• Topical antibiotics should be prescribed to prevent acute bacterial keratitis in patients who wear contact lenses and present with a corneal abrasion, as well as in patients who have suffered trauma 1.
• Fluoroquinolones such as moxifloxacin 0.5% or ciprofloxacin 0.3% drops can be used 4 times daily, especially for contact lens wearers who have a higher risk of Pseudomonas infection 1.
• The antibiotic should be continued until the abrasion has completely healed, which typically takes 24-72 hours for minor abrasions.
• Patients should avoid wearing contact lenses during treatment and for at least 24 hours after the abrasion has healed.
• Pain management with oral analgesics and cycloplegic drops like cyclopentolate 1% may also be necessary.
• It is essential to note that antibiotics are crucial because corneal abrasions disrupt the protective epithelial layer, creating an entry point for bacteria that could lead to serious infections like bacterial keratitis, which can threaten vision if left untreated 1. Some key points to consider when treating corneal abrasions include:
• The use of a cycloplegic agent may decrease pain as well as synechia formation in bacterial keratitis, and is indicated when substantial anterior chamber inflammation is present 1.
• Corticosteroids may be considered after 24 to 48 hours when the causative organism is identified and/or infection is responding to therapy, but should be avoided in cases of infection involving organisms like Acanthamoeba, Nocardia, and fungus 1.
• Awareness of the increased resistance of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa to topical fluoroquinolones is crucial, and alternative treatments such as vancomycin or linezolid may be necessary in some cases 1.

From the FDA Drug Label

Ofloxacin has been shown to be active against most strains of the following organisms both in vitro and clinically, in conjunctival and/or corneal ulcer infections Ofloxacin ophthalmic solution has been shown to be active in vitro against most strains of these organisms but the clinical significance in ophthalmologic infections is unknown. Corneal Ulcers: The recommended dosage regimen for the treatment of corneal ulcers is two drops into the affected eye every 15 minutes for the first six hours and then two drops into the affected eye every 30 minutes for the remainder of the first day. Ciprofloxacin ophthalmic solution is indicated for the treatment of infections caused by susceptible strains of the designated microorganisms in the conditions listed below: Corneal Ulcers: Pseudomonas aeruginosa Serratia marcescens* Staphylococcus aureus Staphylococcus epidermidis Streptococcus pneumoniae

The antibiotic treatment for corneal abrasions includes:

• Ofloxacin 2
• Ciprofloxacin 3 and 3 Key points:
• The treatment regimen for corneal ulcers with ciprofloxacin is two drops into the affected eye every 15 minutes for the first six hours and then two drops into the affected eye every 30 minutes for the remainder of the first day.
• Ofloxacin and ciprofloxacin have been shown to be active against various strains of bacteria that can cause corneal ulcers.

From the Research

Antibiotic Treatment for Corneal Abrasions

• The goals of treatment for corneal abrasions include pain control, prevention of infection, and healing 4.
• Topical antibiotics are commonly prescribed to prevent bacterial superinfection, although evidence is lacking to support their use 4.
• Contact lens-related abrasions should be treated with antipseudomonal topical antibiotics 4.
• A study comparing chloramphenicol ocular ointment with fusidic acid ocular gels found no significant difference in the incidence of infection or time to clinical cure 5.
• Another study investigating the effect of a three-day course of either ocular ointment combinations of chloramphenicol-clotrimazole or chloramphenicol-placebo found no significant difference in the rate of cure or incidence of complications 5.
• Moxifloxacin HCl (0.5% w/v) eye drops are one of the most widely used treatments for corneal abrasion 6.
• A study on dual drug-loaded coaxial nanofibers for the treatment of corneal abrasion found that the antimicrobial activity of moxifloxacin HCl was preserved following encapsulation into the nanofibers 6.

Specific Antibiotic Regimens

• Chloramphenicol ocular ointment and fusidic acid ocular gels have been compared in a study, but the evidence is of very low certainty 5.
• Chloramphenicol-clotrimazole and chloramphenicol-placebo ocular ointment combinations have also been investigated, but the evidence is of very low certainty 5.
• Moxifloxacin HCl (0.5% w/v) eye drops are a commonly used treatment, but there is limited evidence on their efficacy and safety in comparison to other antibiotics 6.

Additional Treatment Considerations

• Pain relief may be achieved with topical nonsteroidal anti-inflammatory drugs or oral analgesics 4.
• Patching is not recommended as it does not improve pain and has the potential to delay healing 4.
• Soft contact lenses and topical diclofenac have been used as an alternative to pressure patching in the treatment of corneal abrasions, providing significant pain relief and allowing patients to function with binocular vision 7.