What is the treatment for bacterial conjunctivitis?

Treatment for Bacterial Conjunctivitis

Topical antibiotics are recommended for bacterial conjunctivitis as they reduce the duration of symptoms and promote faster resolution of infection. 1, 2

First-Line Treatment Options

• Standard cases of bacterial conjunctivitis:

  • Topical fluoroquinolones (e.g., moxifloxacin 0.5% ophthalmic solution): Instill one drop in the affected eye 3 times a day for 7 days 3
  • Topical azithromycin 1% ophthalmic solution: Instill 1 drop in affected eye(s) twice daily for first two days, then once daily for five more days 4
  • Other options: Topical gentamicin, tetracycline, or ofloxacin as endorsed by WHO Essential Medicines List 1

• Contact lens wearers:

  • Must receive topical antibiotics to prevent acute bacterial keratitis 2
  • Avoid patching or therapeutic contact lens use due to increased risk of secondary bacterial keratitis 2
  • Should discontinue contact lens wear until infection resolves 3, 4

Treatment Algorithm Based on Presentation

1. Mild to moderate bacterial conjunctivitis:

   • Topical antibiotic drops/ointment for 7 days
   • Most common pathogens: Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus 5, 6
   • Clinical cure rates with antibiotics: 62% by day 3-5 vs. 28% with placebo 7

2. Severe purulent conjunctivitis:

   • Consider sexually transmitted infections (gonorrhea, chlamydia)
   • Requires systemic antibiotics in addition to topical therapy 6
   • For gonococcal conjunctivitis: systemic ceftriaxone 2
   • For chlamydial conjunctivitis: systemic erythromycin or azithromycin 2

3. Neonatal conjunctivitis:

   • Identify etiologic agent based on onset time:
     • 1-7 days: Consider gonococcal infection
     • 5-19 days: Consider chlamydial infection
     • First week: Common bacterial pathogens (S. aureus, Enterococcus, etc.) 2
   • Systemic treatment mandatory for gonococcal and chlamydial infections 2

Important Considerations

• While bacterial conjunctivitis is often self-limiting, topical antibiotics:

  • Shorten duration of clinical disease
  • Enhance eradication of causative organisms 7
  • Allow earlier return to school or work 6

• Bacterial resistance concerns:

  • Consider local resistance patterns when selecting antibiotics 8
  • For suspected MRSA, consider topical vancomycin 2
  • Avoid prolonged use to prevent overgrowth of non-susceptible organisms 3, 4

• Patient instructions:

  • Proper hand hygiene
  • Avoid sharing towels and cloths
  • Complete full course of antibiotics to prevent resistance 4
  • Avoid touching or rubbing eyes

Special Situations

• Chronic conjunctivitis:

  • Usually associated with blepharitis or meibomianitis
  • Requires good eyelid hygiene and topical antibiotics based on culture 9

• Allergic component:

  • If itching is the predominant symptom, consider allergic conjunctivitis
  • Treatment includes topical antihistamines and mast cell stabilizers 6, 9

• Pediatric cases:

  • Refer to pediatric ophthalmologist if not responding to initial antibiotic therapy within 3 weeks 2

Bacterial conjunctivitis typically resolves within 1-2 weeks even without treatment, but antibiotic therapy accelerates recovery and reduces contagion period, making it the recommended approach for most cases 6.