What is the treatment for bacterial conjunctivitis?

Treatment of Bacterial Conjunctivitis

Topical antibiotics are the first-line treatment for bacterial conjunctivitis, providing higher local concentration, fewer systemic side effects, and a shorter treatment duration of 5-7 days. 1

First-Line Treatment Options

The American Academy of Ophthalmology recommends a 5-7 day course of broad-spectrum topical antibiotics for mild bacterial conjunctivitis in adults 1. The WHO Expert Committee endorses the following options:

• Topical gentamicin
• Topical tetracycline
• Topical ofloxacin 2

For standard dosing of fluoroquinolones (e.g., gatifloxacin):

• Day 1: One drop every two hours while awake (up to 8 times)
• Days 2-7: One drop 2-4 times daily while awake 3

Efficacy and Selection Considerations

• Topical antibiotics provide earlier clinical and microbiological remission compared to placebo, particularly in days 2-5 of treatment 2, 1
• No clinical evidence suggests superiority of any particular antibiotic for bacterial conjunctivitis, allowing selection of the most convenient or least expensive option 1
• Bacterial resistance should be considered when selecting an antibiotic, as resistance to fluoroquinolones appears to be increasing, particularly with methicillin-resistant Staphylococcus aureus (MRSA) 2

Special Populations and Situations

Children

• Standard topical antibiotics are appropriate for most pediatric cases
• Systemic therapy with oral erythromycin (50 mg/kg/day divided into four doses) for 14 days may be necessary in certain cases 1

Severe or Specific Infections

• For gonorrheal conjunctivitis: Combination therapy with systemic ceftriaxone (25-50 mg/kg IV or IM, single dose, not to exceed 125 mg) plus topical antibiotic therapy 1
• For chlamydial conjunctivitis: Systemic treatment in addition to topical therapy 4
• For contact lens wearers with purulent conjunctivitis: Topical and systemic broad-spectrum antibiotics 2

When to Consider Delayed Antibiotic Treatment

Delayed antibiotic prescribing has been found to have similar symptom control as immediate prescribing 5. This approach may be considered for mild cases since:

• 41% of patients with bacterial conjunctivitis are cured by days 6-10 without antibiotics 2
• Uncomplicated cases often resolve in 1-2 weeks without treatment 4

Prevention and Hygiene Measures

• Frequent handwashing
• Avoiding sharing towels and pillowcases
• Changing pillowcases frequently during infection
• Avoiding touching or rubbing eyes
• Appropriate lens care for contact lens wearers 1

When to Refer to Ophthalmology

Immediate referral is indicated for:

• Conjunctivitis in a neonate
• Severe pain
• Decreased vision
• Recent ocular surgery
• Vesicular rash on the eyelids or nose
• History of rheumatologic disease
• Immunocompromised state
• Lack of response to therapy after 3-4 days 1, 5

Common Pitfalls to Avoid

• Overuse of antibiotics for viral conjunctivitis
• Prolonged use of corticosteroids without ophthalmology supervision
• Failure to recognize potentially serious causes of conjunctivitis
• Inadequate hygiene education
• Delayed referral for severe or non-responsive cases 1

Patients with bacterial conjunctivitis can typically return to work or school after 24 hours of antibiotic treatment 1.