Treatment of Bacterial Conjunctivitis
The first-line treatment for bacterial conjunctivitis is a 5- to 7-day course of a broad-spectrum topical antibiotic, with moxifloxacin 0.5% ophthalmic solution administered three times daily for 7 days being a recommended option. 1
Diagnosis and Antibiotic Selection
- Bacterial conjunctivitis is typically diagnosed clinically based on signs and symptoms
- Conjunctival cultures and Gram staining should be obtained if:
- Gonococcal infection is suspected
- MRSA is a concern (especially in nursing home residents)
- Community-acquired infections are not responding to initial therapy 1
First-Line Treatment Options
Standard Treatment Regimen
- Moxifloxacin 0.5% ophthalmic solution: Instill one drop in the affected eye 3 times a day for 7 days 2
- Moxifloxacin is effective against common bacterial conjunctivitis pathogens including:
- Staphylococcus aureus
- Staphylococcus epidermidis
- Streptococcus pneumoniae
- Haemophilus influenzae
- Chlamydia trachomatis 2
Alternative Options
According to the WHO Essential Medicines recommendations, other effective options include:
- Topical gentamicin
- Topical tetracycline
- Topical ofloxacin 3
Treatment Efficacy and Duration
- Topical antibiotics are associated with earlier clinical and microbiological remission compared to placebo, particularly in days 2-5 of treatment 1
- Clinical evidence does not suggest superiority of any particular antibiotic, allowing selection based on convenience, cost, and local resistance patterns 1
- Studies show that topical antibiotics decrease the duration of symptoms and may reduce transmissibility 1
Special Considerations
Severe or Specific Infections
- For gonococcal or chlamydial conjunctivitis: Systemic antibiotics may be required in addition to topical treatment 3
- For trachoma: Single-dose oral azithromycin or a week of oral tetracycline (for adults) is recommended 3
Pediatric Patients
- Systemic therapy with oral erythromycin (50 mg/kg/day divided into four doses for 14 days) may be necessary for certain cases of bacterial conjunctivitis in children 1
- Combination therapy with systemic ceftriaxone plus topical antibiotics may be required in severe cases 1
Antibiotic Resistance and Treatment Adherence
- The increasing prevalence of MRSA necessitates appropriate antibiotic selection 1
- Completing the full course of treatment is crucial to prevent resistance development 1
- Prolonged use of antibiotics should be avoided to prevent overgrowth of non-susceptible organisms, including fungi 2
Prevention and Transmission Control
- Patients can typically return to work or school after 24 hours of antibiotic treatment 1
- Preventive measures include:
- Frequent handwashing
- Avoiding sharing towels and pillowcases
- Changing pillowcases frequently during infection
- Avoiding touching or rubbing eyes 1
- Contact lens wearers should discontinue lens use during active infection 2
Common Pitfalls to Avoid
- Overuse of antibiotics for viral conjunctivitis: Ensure proper diagnosis before initiating antibiotic therapy
- Prolonged use of corticosteroids without ophthalmology supervision: This can worsen bacterial infections
- Inadequate treatment duration: Complete the full course of antibiotics even if symptoms improve
- Delayed referral for severe or non-responsive cases: Refer immediately if no improvement after 3-4 days of treatment 1
Indications for Specialist Referral
Immediate referral is recommended for patients with:
- Visual loss
- Moderate or severe pain
- Severe purulent discharge
- Corneal involvement
- Conjunctival scarring
- Lack of response to therapy after 3-4 days
- Recurrent episodes
- History of herpes simplex virus eye disease
- Immunocompromised status 1