What is the treatment for bacterial conjunctivitis?

Treatment of Bacterial Conjunctivitis

Topical antibiotic therapy is the recommended first-line treatment for bacterial conjunctivitis, with options including gentamicin, tetracycline, ofloxacin, or moxifloxacin 0.5% ophthalmic solution. 1

First-Line Treatment Options

Standard Cases

• First-line antibiotics:
  • Gentamicin ophthalmic solution
  • Tetracycline ophthalmic solution
  • Ofloxacin ophthalmic solution
  • Moxifloxacin 0.5% ophthalmic solution 1, 2
  • Azithromycin ophthalmic solution 3

Dosing Regimens

• Moxifloxacin 0.5%: Instill one drop in affected eye(s) 3 times daily for 7 days 2
• Azithromycin 1%: Instill one drop in affected eye(s) twice daily, 8-12 hours apart for first 2 days, then once daily for 5 more days 3

Special Cases Requiring Different Management

Gonococcal Conjunctivitis

• Requires BOTH systemic AND topical therapy:
  • Systemic: Ceftriaxone (single dose)
  • Plus topical antibiotic therapy 1

Chlamydial Conjunctivitis

• Requires systemic therapy with one of:
  • Azithromycin (1g orally, single dose) OR
  • Doxycycline (100mg orally twice daily for 7 days) OR
  • Levofloxacin (500mg orally once daily for 7 days) 1

Neonatal Conjunctivitis

• Treatment depends on time of onset:
  • 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 Duration and Response

• Standard treatment course: 5-7 days 1
• Continue treatment until:
  • Resolution of discharge
  • No more mattering of eyelids in the morning
  • Reduction in conjunctival injection 1
• Clinical improvement typically occurs within 1-3 days of appropriate therapy 1
• Complete the full course of antibiotics to prevent resistance development 3, 2

Red Flags Requiring Ophthalmology Referral

Immediate referral is indicated for:

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

Practical Administration Tips

1. Wash hands before administration
2. Avoid contaminating the applicator tip
3. Remove contact lenses if present (patients should not wear contacts during active infection)
4. Tilt head back and instill prescribed number of drops
5. Complete the full course of therapy to prevent resistance 3, 2

Evidence Quality and Considerations

The American Academy of Ophthalmology guidelines provide strong recommendations for antibiotic selection and management 1. Clinical studies have demonstrated that topical antibiotics significantly accelerate recovery compared to placebo, with 62% of treated patients showing clinical cure by days 3-5 versus only 28% in placebo groups 4.

While bacterial conjunctivitis is generally self-limiting (with 72% of untreated cases resolving by days 8-10), antibiotic treatment speeds recovery and enhances pathogen eradication 1, 4.

The most common pathogens in bacterial conjunctivitis include Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, and Moraxella species 5, 6. Fluoroquinolones like moxifloxacin have demonstrated good activity against these common pathogens 7.

Prevention Measures

• Frequent handwashing
• Avoid sharing towels and pillowcases
• Proper contact lens care
• Patients can typically return to work/school after 24 hours of antibiotic treatment 1