What are the recommended drops for treating bacterial conjunctivitis?

From the Guidelines

For the treatment of bacterial conjunctivitis, antibiotic eye drops such as fluoroquinolones, aminoglycosides, or macrolides are recommended, with a typical treatment duration of 5-7 days. The choice of antibiotic is usually empiric, and because a 5- to 7-day course of a broad-spectrum topical antibiotic is usually effective, the most convenient or least expensive option can be selected 1.

Key Considerations

• Mild bacterial conjunctivitis is usually self-limited and may resolve spontaneously without specific treatment in immune-competent adults, but topical antibacterial therapy can lead to earlier clinical and microbiological remission compared to placebo 1.
• For moderate to severe bacterial conjunctivitis, conjunctival cultures and slides for Gram staining should be obtained, especially if gonococcal infection is a possibility, to guide the choice of antibiotic 1.
• Methicillin-resistant S. aureus (MRSA) has been isolated with increasing frequency from patients with bacterial conjunctivitis, and microbiology laboratory testing may guide therapy, which may include compounded topical antibiotics such as vancomycin 1.

Treatment Approach

• Common first-line options include fluoroquinolones (such as ciprofloxacin, ofloxacin, or moxifloxacin), aminoglycosides (like tobramycin or gentamicin), or macrolides (such as erythromycin or azithromycin) 1.
• These drops are typically administered 1-2 drops in 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 treatment duration of 5-7 days.
• It's essential to complete the full course of treatment even if symptoms improve earlier to prevent recurrence.
• Before applying drops, wash hands thoroughly and avoid touching the dropper tip to prevent contamination.
• Wipe away any discharge from the eye with clean, warm water before application.

Monitoring and Follow-Up

• If symptoms don't improve within 48-72 hours of treatment, or if vision becomes affected, seeking further medical evaluation is recommended as this may indicate a different type of infection or condition 1.

From the FDA Drug Label

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. One or two drops instilled into the conjunctival sac(s) every four to six hours. During the initial 24 to 48 hours, the dosage may be increased to one or two drops every two (2) hours.

The recommended drops for treating bacterial conjunctivitis are:

• Ciprofloxacin (OPHTH): 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 2
• Tobramycin (OPHTH): one or two drops instilled into the conjunctival sac(s) every four to six hours, with the option to increase to one or two drops every two hours during the initial 24 to 48 hours 3

From the Research

Recommended Drops for Treating Bacterial Conjunctivitis

The following drops are recommended for treating bacterial conjunctivitis:

• Moxifloxacin 0.5% ophthalmic solution, which has been shown to be effective in eradicating the three principle causative pathogens of bacterial conjunctivitis, including Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus 4, 5, 6
• Besifloxacin ophthalmic suspension 0.6%, which has been found to be non-inferior to moxifloxacin ophthalmic solution 0.5% in terms of clinical and microbiological efficacy 7
• Pazufloxacin 0.6% ophthalmic solution, which has been shown to have similar rates of bacterial eradication and clinical remission compared to other fluoroquinolones, including moxifloxacin and gatifloxacin 8
• Polymyxin B sulfate/trimethoprim ophthalmic solution, which has been compared to moxifloxacin in terms of speed of clinical efficacy for the treatment of bacterial conjunctivitis 5

Key Findings

• Moxifloxacin 0.5% ophthalmic solution has been found to be effective in treating bacterial conjunctivitis, with a microbiological success rate of 74.5% compared to 56.0% for its vehicle control 4
• Besifloxacin ophthalmic suspension 0.6% has been found to be non-inferior to moxifloxacin ophthalmic solution 0.5% in terms of clinical and microbiological efficacy, with no statistically significant difference between the two treatment groups 7
• Pazufloxacin 0.6% ophthalmic solution has been found to have similar rates of bacterial eradication and clinical remission compared to other fluoroquinolones, including moxifloxacin and gatifloxacin 8

Treatment Options

• Moxifloxacin 0.5% ophthalmic solution can be dosed twice-daily for 3 days 4
• Besifloxacin ophthalmic suspension 0.6% can be instilled three times daily for 5 days 7
• Pazufloxacin 0.6% ophthalmic solution can be dosed three times daily 8
• Polymyxin B sulfate/trimethoprim ophthalmic solution can be dosed four times daily for 7 days 5