What antibiotics are used to treat a stye (hordeolum)?

Antibiotic Treatment for Styes (Hordeolum)

For styes (hordeolum), first-line treatment is warm compresses and eyelid hygiene, with erythromycin ophthalmic ointment applied to the eyelid margins 1-4 times daily for 7-10 days when signs of infection are present. 1

Treatment Algorithm

First-Line Treatment

• Warm compresses: Apply for 10-15 minutes, 3-4 times daily
• Eyelid hygiene: Clean eyelids with mild soap or commercial eyelid cleanser
• Gentle massage: To promote drainage

Second-Line Treatment (for signs of infection)

• Topical antibiotics:
  • Erythromycin ophthalmic ointment: Apply to eyelid margins 1-4 times daily for 7-10 days 1
  • Alternative: Bacitracin ophthalmic ointment

Third-Line Treatment (for moderate to severe cases)

• Oral antibiotics (if no response to topical treatment):
  • For adults: Doxycycline, minocycline, or clindamycin 2
  • For children <8 years: Clindamycin (tetracyclines contraindicated) 2, 1

Fourth-Line Treatment (for persistent cases)

• Incision and drainage: For persistent (>2 weeks) or large styes 1
• Intralesional steroid injection: For persistent chalazia 1

Antibiotic Selection Details

Topical Antibiotics

• First choice: Erythromycin ophthalmic ointment 1
• Alternative options:
  • Bacitracin ophthalmic ointment
  • Combination of neomycin, polymyxin, and gramicidin eye drops 3
  • Chloramphenicol eye ointment 3

Oral Antibiotics (for moderate to severe cases)

• For empirical coverage of CA-MRSA in outpatients with skin infections:
  • Clindamycin (first choice) 2
  • Trimethoprim-sulfamethoxazole (TMP-SMX) 2
  • Tetracyclines (doxycycline or minocycline) - not for children <8 years 2
  • Linezolid 2

Important Considerations

• Duration of treatment: 7-10 days for topical antibiotics; 5-10 days for oral antibiotics 2, 1
• Tetracyclines are contraindicated in pregnant women, nursing mothers, and children under 8 years of age 2, 1
• Avoid rifampin as single agent or adjunctive therapy for skin infections 2
• Monitor for resistance: Consider rotating antibiotics if repeated courses are needed 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

• Regular eyelid hygiene
• Complete removal of eye makeup
• Treatment of underlying conditions (e.g., blepharitis, rosacea)
• Discontinue contact lens wear until symptoms resolve 1

Despite the common occurrence of hordeola, there is limited high-quality evidence regarding their treatment. The Cochrane reviews found no randomized controlled trials specifically evaluating non-surgical interventions for acute internal hordeolum 4, 5. However, clinical practice guidelines consistently recommend warm compresses, eyelid hygiene, and topical antibiotics as the mainstay of treatment, with oral antibiotics reserved for more severe or unresponsive cases.