From the Research
For a hordeolum (stye) resistant to erythromycin, I recommend switching to bacitracin or bacitracin-polymyxin B ointment applied to the affected eyelid margin 3-4 times daily for 7-10 days, as there is no strong evidence to support a specific alternative treatment, and this option is based on general medical knowledge and the need to prioritize morbidity, mortality, and quality of life. The provided evidence does not offer a clear alternative treatment for a hordeolum resistant to erythromycin, as the studies either did not find relevant trials or reported on external hordeola or chronic internal hordeola 1, 2, 3. However, considering the potential for severe complications such as eyelid deformity, systemic involvement, and blindness if left untreated or misdiagnosed 4, it is crucial to prioritize effective treatment. Given the lack of strong evidence, the recommendation is based on the principle of using alternative antibiotic classes that may overcome resistance to erythromycin. In addition to antibiotic therapy, warm compresses should be applied to the affected eye for 10-15 minutes, 4 times daily to help bring the stye to a head and promote drainage. If the hordeolum doesn't respond to topical antibiotics within 48-72 hours, shows signs of spreading infection, or is particularly large or painful, oral antibiotics such as dicloxacillin 250-500 mg four times daily or cephalexin 500 mg four times daily for 7 days may be necessary. It's also worth noting that one study found no statistically significant difference between combined antibiotic ophthalmic solution and placebo in the treatment of hordeolum after incision and curettage 5, but this does not directly address the question of alternative treatments for erythromycin-resistant hordeolum. Therefore, the recommendation prioritizes the use of alternative antibiotics and supportive care to manage the condition effectively and prevent potential complications.