What is the treatment for bacterial conjunctivitis?

Treatment for Bacterial Conjunctivitis

Topical antibiotics are recommended for bacterial conjunctivitis as they decrease the duration of symptoms, allow earlier return to work or school, and prevent complications. 1

First-Line Treatment

Standard Cases

• First-line therapy: 5-7 day course of broad-spectrum topical antibiotic 1
  • Moxifloxacin 0.5% ophthalmic solution: Instill one drop in affected eye 3 times daily for 7 days 2
  • Alternatives: Topical gentamicin, tetracycline, or ofloxacin 3

Dosing Instructions

• Wash hands before application
• Tilt head back and instill one drop into affected eye(s)
• Avoid touching the applicator tip to the eye or any surface 2, 4
• Patients should not wear contact lenses during treatment 2, 4

Special Considerations

Based on Causative Organism

• Moxifloxacin is effective against common pathogens including:
  • Staphylococcus aureus
  • Staphylococcus epidermidis
  • Streptococcus pneumoniae
  • Haemophilus influenzae 2

Severe or Specific Cases

• Gonococcal conjunctivitis: Requires systemic antibiotics in addition to topical therapy 1
• Chlamydial conjunctivitis: Requires systemic treatment 1
  • For trachoma: Single-dose oral azithromycin or a week of oral tetracycline (for adults) 3

Neonatal Conjunctivitis

• Requires immediate consultation 1
• Treatment based on onset time:
  • 1-7 days after birth: Consider gonococcal infection
  • 5-19 days: Consider chlamydial infection
  • First week: Common bacterial pathogens (S. aureus, Enterococcus, etc.) 1

Treatment Response and Duration

• Clinical improvement typically occurs within 1-3 days of appropriate antibiotic treatment 1
• Patients can usually return to work or school after 24 hours of treatment 1
• Complete the full course of treatment even if symptoms improve 1, 4
• If symptoms persist after 3-4 days of appropriate therapy, consider:
  • Alternative diagnosis
  • Different antibiotic
  • Ophthalmology referral 1

Prevention and Hygiene Measures

• Frequent handwashing
• Avoid sharing towels and pillowcases
• Proper contact lens care 1

Common Pitfalls to Avoid

1. Incomplete treatment course: Skipping doses or stopping early may decrease effectiveness and increase bacterial resistance 4
2. Overuse of antibiotics: Not all conjunctivitis cases require antibiotics, but bacterial cases benefit from treatment 3, 5
3. Delayed referral: Immediate referral is needed for severe pain, decreased vision, corneal involvement, or lack of response to therapy 1
4. Inadequate hygiene education: Proper hygiene is crucial to prevent spread 1

Red Flags Requiring Specialist Referral

• Moderate to severe pain
• Decreased vision
• Corneal involvement
• Conjunctival scarring
• Lack of response after 3-4 days of therapy
• Recurrent episodes
• History of herpes simplex virus eye disease
• Immunocompromised patients 1

While most cases of bacterial conjunctivitis are self-limiting, with 41% of untreated patients showing clinical cure by days 6-10 3, treatment with topical antibiotics significantly accelerates recovery and reduces symptom duration 6.