From the Guidelines
Bacterial conjunctivitis is typically self-limited and can be treated with a 5- to 7-day course of 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. The choice of antibiotic is usually empiric, and treatment may reduce transmissibility and allow for an earlier return to school for children 1.
Key Considerations
- Mild bacterial conjunctivitis usually resolves spontaneously without specific treatment in immune-competent adults, but topical antibacterial therapy can lead to earlier clinical and microbiological remission compared to placebo 1.
- 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 1.
- For moderate to severe bacterial conjunctivitis, conjunctival cultures and slides for Gram staining should be obtained, and the choice of antibiotic is guided by the results of laboratory tests 1.
Treatment Approach
- First-line treatments include broad-spectrum topical antibiotics, which should be applied as directed, usually 1-2 drops in the affected eye(s) every 2-4 hours while awake for drops, or a small ribbon of ointment 3-4 times daily for ointments.
- Treatment should continue for 5-7 days, even if symptoms improve sooner.
- When applying eye medication, it is essential to wash hands thoroughly before and after application, avoid touching the tip of the container to any surface, including the eye, and wipe away excess discharge with clean, warm water before application.
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 recommended treatment for bacterial conjunctivitis is gatifloxacin ophthalmic solution, 0.5%. The dosage is:
- 1 drop every 2 hours in the affected eye(s) while awake, up to 8 times on Day 1
- 1 drop 2 to 4 times daily in the affected eye(s) while awake on Days 2 through 7 2
From the Research
Treatment Options for Bacterial Conjunctivitis
- The recommended treatment for bacterial conjunctivitis includes the use of topical antibiotics, such as moxifloxacin, to reduce the duration and severity of symptoms 3, 4, 5, 6.
- Moxifloxacin 0.5% ophthalmic solution has been shown to be effective in treating bacterial conjunctivitis, with a high clinical success rate and good penetration into ocular tissues 3, 6.
- The use of moxifloxacin has been compared to other antibiotics, such as polymyxin B sulfate/trimethoprim and levofloxacin, and has been found to be more effective in some cases 3, 6.
Dosage and Administration
- Moxifloxacin 0.5% ophthalmic solution can be administered three times daily for 7 days, or twice daily for 3 days, depending on the formulation and patient population 3, 4.
- The use of a xanthan gum-based formulation of moxifloxacin has been shown to provide effective eradication of bacterial conjunctivitis pathogens, with a microbiological success rate of 74.5% 4.
Resistance and Safety
- The use of moxifloxacin has been found to have a low risk of selecting for fluoroquinolone resistance among bacteria isolated from the skin, nose, and throat 7.
- Moxifloxacin 0.5% ophthalmic solution has been found to be well tolerated, with ocular adverse events, such as eye pain and eye irritation, being the most commonly reported treatment-related adverse events 6.