What is the treatment for bacterial conjunctivitis (pink eye) with antibiotic drops?

Treatment of Bacterial Conjunctivitis with Antibiotic Drops

For bacterial conjunctivitis (pink eye), topical antibiotic drops such as moxifloxacin 0.5% administered three times daily for 7 days is the recommended treatment due to its superior efficacy and faster resolution of symptoms compared to other antibiotics. 1, 2

Diagnosis of Bacterial Conjunctivitis

Before initiating treatment, it's important to identify bacterial conjunctivitis, which is characterized by:

• Mucopurulent discharge
• Matted eyelids, especially upon waking
• Lack of itching (which would suggest allergic conjunctivitis)
• No history of previous conjunctivitis 3

First-Line Antibiotic Treatment Options

Recommended Antibiotic Drops:

1. Moxifloxacin 0.5% ophthalmic solution

   • Dosing: 1 drop in affected eye 3 times daily for 7 days
   • Effective against common bacterial pathogens including Staphylococcus, Streptococcus, and Haemophilus influenzae
   • Achieves faster clinical resolution (81% resolution at 48 hours) 1, 2

2. Alternative options:

   • Gentamicin ophthalmic solution
   • Ofloxacin ophthalmic solution
   • Polymyxin B/trimethoprim ophthalmic solution (4 times daily) 3, 4

Special Considerations

For Specific Pathogens:

• Gonococcal conjunctivitis: Requires systemic antibiotics (ceftriaxone) in addition to topical therapy 5
• Chlamydial conjunctivitis: Requires systemic antibiotics (azithromycin or doxycycline) 5

For Special Populations:

• Children: Same topical antibiotics as adults, with dosage adjustments for systemic therapy when needed 5
• Contact lens wearers: Should discontinue lens wear until infection resolves 1
• Pregnant women: Avoid doxycycline, quinolones, or tetracyclines; erythromycin or amoxicillin recommended for chlamydial infection 5

Treatment Course and Expectations

• Most uncomplicated bacterial conjunctivitis resolves within 1-2 weeks 6
• Patients can typically return to work or school after 24 hours of antibiotic treatment 3
• Clinical improvement should be seen within 48-72 hours of starting appropriate antibiotic therapy 2

Important Precautions

• Avoid prolonged antibiotic use to prevent development of resistant organisms 1, 7
• Discontinue treatment if hypersensitivity reactions occur 1
• Avoid contact lens wear during the infection period 1
• Practice good hygiene to prevent spread:
  • Frequent handwashing
  • Avoid sharing towels and pillowcases
  • Avoid touching or rubbing eyes 3

When to Refer to Specialist

Immediate referral to ophthalmology is necessary for:

• Visual loss
• Moderate to severe pain
• Severe purulent discharge
• Corneal involvement
• Lack of response to therapy within 48-72 hours
• Recurrent episodes 3

Treatment Pitfalls to Avoid

• Using antibiotics for viral conjunctivitis (most common form of conjunctivitis)
• Inadequate hygiene education leading to spread of infection
• Delayed referral for severe or non-responsive cases
• Inappropriate use of corticosteroids which can potentiate infections 3