What is the treatment for bacterial conjunctivitis?

From the Guidelines

Bacterial conjunctivitis is typically treated with a 5- to 7-day course of broad-spectrum topical antibiotics, which can reduce symptom duration and prevent transmission to others, as evidenced by the most recent study in 2024 1. The choice of antibiotic is usually empiric, and there is no clinical evidence suggesting the superiority of any particular antibiotic.

• Mild bacterial conjunctivitis is usually self-limited and can resolve spontaneously without specific treatment in immune-competent adults.
• However, topical antibacterial therapy can lead to earlier clinical and microbiological remission compared to placebo.
• 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. Key considerations in treating bacterial conjunctivitis include:
• Applying the medication to the affected eye(s) 3-4 times daily for 5-7 days, even if symptoms improve before completing the course.
• Gently cleaning any discharge from the eyes with warm water and a clean cloth before each application.
• Washing hands thoroughly before and after application to prevent spreading the infection.
• Contact lens wearers should stop wearing lenses until the infection clears completely. It's essential to note that while bacterial conjunctivitis often resolves on its own within 7-14 days, antibiotic treatment can speed recovery and reduce symptom duration, as supported by the study in 2024 1. If symptoms worsen or don't improve after 48 hours of treatment, patients should seek further medical evaluation, as indicated by the study in 2019 1. Additionally, the study in 2024 1 highlights the importance of proper hygiene and avoiding close contact with others during the period of contagion to prevent the transmission of epidemic adenoviral conjunctivitis.

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 is gatifloxacin ophthalmic solution, 0.5%. The dosage is:

• Day 1: Instill one drop every two hours in the affected eye(s) while awake, up to 8 times.
• Days 2-7: Instill one drop two to four times daily in the affected eye(s) while awake. 2

From the Research

Treatment Options for Bacterial Conjunctivitis

• Topical antibiotic therapy is beneficial in treating bacterial conjunctivitis, as it shortens the duration of clinical disease and enhances eradication of the causative organism from the conjunctiva 3.
• Systemic antibiotic therapy, such as oral cefixime, may not be more effective than topical antibiotic therapy in eradicating conjunctival colonization with respiratory pathogens or preventing acute otitis media 4.
• Topical moxifloxacin, a new antibacterial, has been shown to be effective in treating bacterial conjunctivitis, with a higher potency and faster in vitro "speed-to-kill" compared to non-fluoroquinolones 5.
• A new ophthalmic formulation of moxifloxacin, dosed twice-daily for 3 days, has been shown to be effective in eradicating the three principle causative pathogens of bacterial conjunctivitis, including Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus 6.

Benefits of Antibiotic Therapy

• Antibiotic therapy is associated with modestly improved rates of clinical and microbiological remission in comparison to placebo 7.
• Topical antibiotics have been shown to improve "early" (days two to five) clinical and microbiological remission rates, as well as "late" (days six to 10) clinical and microbiological cure rates 7.
• The use of antibiotic eye drops can speed the resolution of symptoms and infection, although acute bacterial conjunctivitis is frequently self-limiting 7.

Considerations for Treatment

• The choice of antibiotic therapy should be based on the severity of the infection, the susceptibility of the causative organism, and the potential for resistance 5.
• Topical fluoroquinolones, such as moxifloxacin, may be considered earlier in the treatment path for conjunctivitis, due to their high potency and favorable pharmacokinetic/pharmacodynamic characteristics 5.