What antibiotic drop is recommended for a stye?

Antibiotic Treatment for Stye

For a stye (hordeolum), topical erythromycin ophthalmic ointment applied directly to the affected eyelid up to six times daily is the recommended first-line antibiotic treatment. 1

Understanding Styes

A stye (hordeolum) is a localized infection of an eyelid gland, typically caused by Staphylococcus bacteria. Styes can be:

• Internal (affecting meibomian glands)
• External (affecting glands of Zeis or Moll)

Treatment Approach

First-Line Treatment

1. Topical Erythromycin Ophthalmic Ointment
   • Apply approximately 1 cm directly to the affected eye/eyelid
   • Frequency: Up to six times daily depending on severity 1
   • Duration: 7-14 days 2

Alternative Topical Antibiotics

If erythromycin is unavailable or ineffective:

• Bacitracin ophthalmic ointment

  • Apply to eyelid margins one or more times daily 3
  • Particularly effective for anterior blepharitis

• Topical tobramycin/dexamethasone ophthalmic suspension

  • Consider for cases with significant inflammation 3
  • Note: Combination antibiotic-steroid preparations should be used with caution due to potential steroid-related complications

For Severe or Recurrent Cases

For styes that don't respond to topical treatment or in cases of recurrent infection:

• Oral antibiotics options:
  • Doxycycline: 100 mg twice daily 2
  • Minocycline: 100 mg twice daily 2
  • Erythromycin: For children or pregnant women (when tetracyclines are contraindicated) 3

Adjunctive Measures

In addition to antibiotic therapy:

1. Warm compresses

   • Apply to affected eyelid for 5-10 minutes, 3-4 times daily
   • Helps promote drainage and resolution

2. Eyelid hygiene

   • Gentle cleansing of eyelid margins
   • Removes debris and reduces bacterial load

Important Considerations

• Tetracyclines (doxycycline, minocycline):

  • Contraindicated in pregnancy and children under 8 years 3
  • May cause photosensitivity and gastrointestinal upset

• Duration of therapy:

  • Topical antibiotics: 7-14 days 2
  • Oral antibiotics: May require 2-4 weeks for complete resolution 3

• When to refer to ophthalmology:

  • No improvement after 48-72 hours of treatment
  • Visual changes
  • Spreading infection/cellulitis
  • Recurrent styes

Evidence Quality

The evidence for antibiotic treatment of styes is primarily based on clinical practice guidelines rather than high-quality randomized controlled trials. A Cochrane review found no randomized controlled trials specifically evaluating nonsurgical treatments for acute internal hordeolum 4. However, clinical practice guidelines from ophthalmology societies consistently recommend topical antibiotics as first-line therapy, with oral antibiotics reserved for more severe or recurrent cases.

The FDA-approved labeling for erythromycin ophthalmic ointment supports its use for superficial ocular infections 1, making it an appropriate first-line choice for styes.