What is the recommended treatment for bacterial conjunctivitis in adults?

Treatment of Bacterial Conjunctivitis in Adults

For bacterial conjunctivitis in adults, topical fluoroquinolones such as gatifloxacin 0.5% ophthalmic solution are recommended, instilled as one drop every two hours while awake (up to 8 times) on Day 1, followed by one drop 2-4 times daily on Days 2-7. 1

Diagnosis and Clinical Presentation

• Bacterial conjunctivitis typically presents with:

  • Mucopurulent discharge
  • Eyelids matted shut, especially upon waking
  • Bilateral or unilateral redness
  • Mild discomfort rather than significant pain

• Common causative organisms include:

  • Staphylococcus aureus
  • Staphylococcus epidermidis
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Streptococcus mitis group
  • Streptococcus oralis 1

Treatment Algorithm

First-line Treatment

1. Topical fluoroquinolones (preferred option):
   • Gatifloxacin 0.5% ophthalmic solution
     • Day 1: One drop every two hours while awake (up to 8 times)
     • Days 2-7: One drop 2-4 times daily 1
   • Moxifloxacin 0.5% is an effective alternative with potentially faster resolution of symptoms 2, 3

Alternative Options

• Polymyxin B/trimethoprim ophthalmic solution (less effective than fluoroquinolones) 2
• Gentamicin, tetracycline, or ofloxacin for standard cases 4

Special Considerations

Contact Lens Wearers

• Patients should be advised to discontinue contact lens wear during treatment 1
• Resume contact lens wear only after complete resolution of infection
• Consider topical antibiotics to prevent acute bacterial keratitis in this high-risk population 4

Hygiene and Prevention

• Strict hand hygiene is critical to prevent spread
• Avoid sharing towels, washcloths, and pillows
• Patients can typically return to work/normal activities after 24 hours of antibiotic treatment 4

Warning Signs Requiring Ophthalmology Referral

• Visual loss
• Moderate or severe pain
• Severe purulent discharge
• Corneal involvement
• Conjunctival scarring
• Lack of response to therapy within 3 weeks
• Recurrent episodes
• History of HSV eye disease
• Immunocompromised status 4

Monitoring and Follow-up

• Reevaluation should be performed in 24-48 hours for simple cases
• Daily evaluation for more severe cases until complete resolution 4
• If no improvement after 48-72 hours of treatment, consider culture and sensitivity testing

Common Pitfalls to Avoid

1. Overuse of antibiotics: Recent research suggests delayed antibiotic prescribing may be appropriate for mild cases 5
2. Inadequate treatment duration: Complete the full course of antibiotics even if symptoms improve
3. Failure to recognize special cases: Neisseria gonorrhoeae and Chlamydia trachomatis infections require aggressive systemic antibiotic therapy 6
4. Prolonged antibiotic use: Can lead to overgrowth of nonsusceptible organisms, including fungi 1

Potential Adverse Effects

Common side effects of topical fluoroquinolones include:

• Worsening of conjunctivitis
• Eye irritation
• Dysgeusia (altered taste)
• Eye pain 1

The most recent evidence shows that fluoroquinolones like gatifloxacin and moxifloxacin provide effective and rapid eradication of common bacterial pathogens causing conjunctivitis, with moxifloxacin demonstrating faster resolution of symptoms in comparative studies 2, 3.