Recommended Eye Drops for Bacterial Conjunctivitis (Pink Eye)
Fourth-generation fluoroquinolone eye drops (moxifloxacin 0.5% or gatifloxacin 0.3%) are the recommended first-line therapy for bacterial conjunctivitis. 1
First-Line Treatment Options
Fluoroquinolone Options
- Moxifloxacin 0.5%: Instill one drop in the affected eye 3 times a day for 7 days 2
- Gatifloxacin 0.3%:
- Day 1: One drop every two hours while awake (up to 8 times)
- Days 2-7: One drop 2-4 times daily 3
Fluoroquinolones are preferred because they:
- Provide broad-spectrum coverage against common conjunctivitis pathogens
- Are bactericidal rather than bacteriostatic
- Have excellent ocular penetration
- Require less frequent dosing than some alternatives 1, 4
Clinical studies show that moxifloxacin 0.5% achieves significantly faster resolution of bacterial conjunctivitis compared to other options, with 81% of patients showing complete resolution within 48 hours 5.
Alternative Treatment Options
If fluoroquinolones are unavailable or contraindicated, the WHO Essential Medicines list recommends:
- Topical gentamicin
- Topical tetracycline
- Topical ofloxacin 6
Specific Pathogen Considerations
Common bacterial pathogens in conjunctivitis include:
- Staphylococcus aureus
- Haemophilus influenzae (most prevalent at 44.8%)
- Streptococcus pneumoniae (30.6%)
- Moraxella catarrhalis 7
For suspected MRSA infections, consider:
- Fortified vancomycin (topical)
- Addition of oral clindamycin or linezolid for severe cases 1
Treatment Duration and Follow-up
- Standard treatment duration: 7 days
- Patients should see improvement within 48-72 hours
- If no improvement after 48-72 hours, consider:
- Culture and sensitivity testing
- Changing antibiotic therapy
- Evaluating for alternative diagnoses 1
Common Pitfalls to Avoid
- Premature discontinuation: Complete the full course even if symptoms improve
- Inadequate dosing frequency: Follow the prescribed schedule
- Contact lens wear: Advise patients to avoid wearing contact lenses until infection resolves
- Delayed modification of ineffective therapy: Change antibiotics if no improvement in 48-72 hours
- Inappropriate corticosteroid use: Avoid steroids initially until infection is controlled 1
Special Populations
For neonates with chlamydial conjunctivitis:
- Erythromycin shows high clinical cure rates (96%)
- Azithromycin (3-day course) is an alternative with 86% cure rate 6
For severe cases or those not responding to topical therapy:
- Consider combination therapy with fortified antibiotics
- Systemic antibiotics may be indicated if infection extends beyond the eye 1
The evidence clearly supports fourth-generation fluoroquinolones as the most effective treatment for bacterial conjunctivitis, with moxifloxacin 0.5% showing particularly rapid clinical efficacy.