What antibiotic medication is used to treat a chronic sty (hordeolum) of the eye?

Antibiotic Treatment for Chronic Styes (Hordeolum)

For chronic styes (hordeolum), a rifampin-based combination with trimethoprim-sulfamethoxazole (TMP-SMX) or doxycycline is the most effective oral antibiotic regimen, administered in short courses of 5-10 days. 1

First-Line Treatment Approach

Non-Pharmacological Management

• Warm compresses: Apply for 10-15 minutes, 3-4 times daily to liquefy thickened sebum, promote drainage, and reduce inflammation 1
• Eyelid hygiene: Gently cleanse eyelid margins with a clean pad or cotton swab to remove crusting from eyelashes 1
• Vertical eyelid massage: To express meibomian gland secretions 1

Topical Antibiotics

• Apply bacitracin or erythromycin ointment to eyelid margins once or more daily for 5-7 days 1
• These reduce bacterial load on the eyelid margin and help prevent recurrence

Oral Antibiotic Options

For MRSA Coverage (Increasingly Common in Chronic Styes)

1. First choice: Rifampin-based combination with TMP-SMX or doxycycline 1
2. Alternative options:
   • Clindamycin: 300-450 mg three times daily for adults or 10-20 mg/kg/day in 3 divided doses for children 1
   • TMP-SMX alone 2
   • Tetracyclines (doxycycline or minocycline) - not for children under 8 years 2

For Methicillin-Sensitive S. aureus

• Dicloxacillin: 500 mg four times daily for adults 1
• Cephalexin: 500 mg four times daily for adults or 25-50 mg/kg/day in 4 divided doses for children 1

Comprehensive Management for Recurrent Cases

For patients with multiple recurrences, consider a comprehensive decolonization strategy:

1. Oral antibiotics (rifampin-based combination) 1
2. Mupirocin nasal ointment twice daily for 5-10 days 2, 1
3. Chlorhexidine body wash or diluted bleach baths 2, 1
4. Continued eyelid hygiene 1

Special Considerations

Pediatric Patients

• Tetracyclines should not be used in children under 8 years of age 2
• For children, mupirocin 2% topical ointment can be used for minor skin infections 2
• Erythromycin is a reasonable alternative to tetracycline in childhood blepharokeratitis 3

Contraindications and Cautions

• Tetracyclines are contraindicated in pregnancy, nursing women, and can cause photosensitization 1
• Oral azithromycin may lead to serious heart rhythm irregularities 1
• Fluoroquinolones are generally poorly effective against MRSA ocular isolates 1

When to Refer to an Ophthalmologist

• Persistent styes (>2 weeks)
• Styes that develop into chalazia
• Suspected MRSA infections
• Visual changes
• Severe eyelid swelling
• Immunocompromised patients 1

Prevention of Recurrence

• Maintain good personal hygiene with regular bathing 2
• Keep draining wounds covered with clean, dry bandages 2
• Remove eye makeup completely 1
• Discontinue contact lens wear until symptoms resolve 1
• Focus cleaning on high-touch surfaces that may contact bare skin 2

It's important to note that despite common clinical practice, there is limited high-quality evidence from randomized controlled trials specifically evaluating treatments for internal hordeola 4, 5. However, the recommendations provided are based on the most recent clinical guidelines from reputable sources.