Treatment of Bacterial Conjunctivitis
Topical antibiotics such as moxifloxacin 0.5% administered three times daily for 7 days are recommended as first-line treatment for bacterial conjunctivitis. 1
Diagnosis and Classification
Before initiating treatment, it's important to identify bacterial conjunctivitis, which is characterized by:
- Mucopurulent discharge
- Matted eyelids, especially upon waking
- Lack of itching (distinguishes from allergic conjunctivitis)
- Absence of watery discharge (more common in viral conjunctivitis)
Standard Treatment Approach
First-line Treatment
- Fluoroquinolones: Moxifloxacin 0.5% three times daily for 7 days 1
- Alternative fluoroquinolone: Gatifloxacin 0.5% with the following dosing schedule 2:
- Day 1: One drop every two hours while awake (up to 8 times)
- Days 2-7: One drop 2-4 times daily
Other Antibiotic Options
- Gentamicin, tetracycline, or ofloxacin are also recommended by the American Academy of Ophthalmology 1
- Besifloxacin 0.6% three times daily for 5 days has shown efficacy similar to moxifloxacin 3
Special Considerations
Specific Pathogens
- Gonococcal conjunctivitis: Requires systemic antibiotics (ceftriaxone) in addition to topical therapy 1
- Chlamydial conjunctivitis: Requires systemic antibiotics (azithromycin or doxycycline) 1
Special Populations
- Children: Same topical antibiotics as adults, with dosage adjustments for systemic therapy when needed 1
- Pregnant women: Avoid doxycycline, quinolones, or tetracyclines; erythromycin or amoxicillin is recommended for chlamydial infection 1
- Contact lens wearers: Should discontinue lens wear during treatment 2
Prevention and Hygiene
To prevent spread of bacterial conjunctivitis:
- Frequent handwashing with soap and water
- Avoid sharing towels, washcloths, and pillows
- Avoid touching or rubbing eyes
- Change pillowcases frequently during infection 1
When to Refer to Ophthalmology
Immediate referral 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 1
Return to Work/School
Patients can typically return to work or school after 24 hours of antibiotic treatment 1
Important Caveats
- Overuse of antibiotics can lead to resistance; delayed antibiotic prescribing has been found to have similar symptom control as immediate prescribing in mild cases 4
- Prolonged use of topical antibiotics may result in overgrowth of nonsusceptible organisms, including fungi 2
- The prevalence of resistance to fluoroquinolones appears to be increasing, particularly with methicillin-resistant S. aureus 5
- Most uncomplicated cases of bacterial conjunctivitis are self-limiting and will resolve within 1-2 weeks even without treatment 6