What are the best eye drops for treating bacterial conjunctivitis?

From the Guidelines

The best eye drops for treating bacterial conjunctivitis are broad-spectrum topical antibiotics, with the most convenient or least expensive option being selected, as there is no clinical evidence suggesting the superiority of any particular antibiotic 1. When treating bacterial conjunctivitis, it is essential to consider the severity of the condition and the potential causative organisms.

• For mild cases, a 5- to 7-day course of a broad-spectrum topical antibiotic is usually effective, and the choice of antibiotic is often empiric 1.
• For moderate to severe cases, conjunctival cultures and slides for Gram staining should be obtained to guide the choice of antibiotic, especially if gonococcal infection is a possibility or if methicillin-resistant S. aureus (MRSA) is suspected 1. Some commonly prescribed antibiotic eye drops for bacterial conjunctivitis include:
• Fluoroquinolones like moxifloxacin (Vigamox), gatifloxacin (Zymar), or ciprofloxacin (Ciloxan)
• Aminoglycosides such as tobramycin (Tobrex)
• Polymyxin B combinations like polymyxin B-trimethoprim (Polytrim) The typical treatment regimen involves applying 1-2 drops to the affected eye(s) every 2-4 hours while awake for the first 1-2 days, then reducing to 4 times daily for a total of 5-7 days, even if symptoms improve sooner 1. It is crucial to follow proper hygiene when using eye drops, including washing hands thoroughly before and after application, avoiding touching the dropper tip to any surface, and gently pulling down the lower eyelid to create a pocket for the drop. If symptoms do not improve within 48-72 hours, or if vision becomes affected, it is essential to seek medical attention, as a different antibiotic may be needed or the diagnosis may need reconsideration 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 The recommended dosage regimen for the treatment of bacterial conjunctivitis is one or two drops instilled into the conjunctival sac(s) every two hours while awake for two days and one or two drops every four hours while awake for the next five days for ciprofloxacin, and Instill one drop in the affected eye 3 times a day for 7 days for moxifloxacin.

Best Eye Drops for Bacterial Conjunctivitis:

• Moxifloxacin (0.5%): Instill one drop in the affected eye 3 times a day for 7 days 2
• Ciprofloxacin: One or two drops instilled into the conjunctival sac(s) every two hours while awake for two days and one or two drops every four hours while awake for the next five days 3

From the Research

Best Eye Drops for Bacterial Conjunctivitis

The following are some of the best eye drops for treating bacterial conjunctivitis:

• Gatifloxacin: A fluoroquinolone antibiotic that has been shown to be effective in treating bacterial conjunctivitis, with a good therapeutic effect and low MIC in vitro 4.
• Levofloxacin: Another fluoroquinolone antibiotic that has been compared to ofloxacin in the treatment of bacterial conjunctivitis, with similar efficacy and safety profiles 4, 5.
• Besifloxacin: A chloro-fluoroquinolone that has been shown to be effective in treating bacterial conjunctivitis, with a broad antibacterial spectrum and low likelihood of bacterial resistance 6.
• Lomefloxacin: A fluoroquinolone antibiotic that has been compared to ofloxacin in the treatment of bacterial conjunctivitis, with similar efficacy and safety profiles 7.
• Ofloxacin: A fluoroquinolone antibiotic that has been used to treat bacterial conjunctivitis, but may have a higher risk of bacterial resistance compared to other options 8, 7, 5.

Key Considerations

When choosing an eye drop for bacterial conjunctivitis, consider the following factors:

• Efficacy: Look for eye drops with high microbial eradication rates and clinical cure rates.
• Safety: Choose eye drops with a low incidence of adverse events and good tolerance.
• Resistance: Consider eye drops with a low likelihood of bacterial resistance, such as besifloxacin.
• Broad-spectrum activity: Look for eye drops with a broad antibacterial spectrum, such as gatifloxacin and levofloxacin.