Treatment for Bacterial Conjunctivitis
Topical broad-spectrum antibiotics for 5-7 days are the first-line treatment for bacterial conjunctivitis, with options including polymyxin B-trimethoprim, gentamicin, or moxifloxacin 0.5% ophthalmic solution. 1
Diagnosis and Classification
Bacterial conjunctivitis typically presents with:
- Purulent or mucopurulent discharge
- Matting of eyelids
- Conjunctival injection (redness)
- Mild discomfort or foreign body sensation
- Absence of significant pain or vision loss 1
Common causative organisms include:
- Haemophilus influenzae
- Streptococcus pneumoniae
- Staphylococcus aureus
- Moraxella species 1
Treatment Algorithm
First-line Treatment
Topical broad-spectrum antibiotics for 5-7 days 1
- Moxifloxacin 0.5% ophthalmic solution: Instill one drop in affected eye 3 times a day for 7 days 2
- Polymyxin B-trimethoprim ophthalmic solution
- Gentamicin ophthalmic solution
Supportive measures
- Warm compresses to soften discharge and loosen crusts 1
- Proper eyelid hygiene to remove discharge
- Frequent handwashing to prevent spread
Special Considerations
- Gonococcal conjunctivitis: Requires both systemic (ceftriaxone) and topical therapy 1
- Chlamydial conjunctivitis: Requires systemic therapy (azithromycin, doxycycline, or levofloxacin) 1
- Neonatal conjunctivitis: Requires immediate referral 1
Efficacy and Evidence
Bacterial conjunctivitis is often self-limiting, with 41% of cases resolving without antibiotics by days 6-10. However, antibiotic treatment speeds resolution of symptoms and reduces the risk of complications and spread 1. Studies show that by day 3-5,62% of patients receiving topical antibiotics were clinically cured compared to only 28% of those given placebo 3.
Moxifloxacin 0.5% is effective against common pathogens including Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, and Haemophilus influenzae 2.
When to Refer to an Ophthalmologist
Refer patients with:
- No response to therapy after 3-4 days
- Moderate or severe pain
- Decreased vision
- Corneal involvement
- Recurrent episodes
- History of herpes simplex virus eye disease
- Immunocompromised status 1
Prevention and Control
- Discontinue contact lens wear until infection resolves
- Consider switching to new lenses after resolution
- Avoid sharing towels, washcloths, and pillowcases
- Proper disinfection of toys and surfaces 1
Important Caveats
Antibiotic resistance: Increasing resistance to fluoroquinolones has been reported, particularly in MRSA isolates. Consider local resistance patterns when selecting antibiotics 1.
Avoid indiscriminate use: Viral conjunctivitis will not respond to antibacterial agents, and mild bacterial conjunctivitis is often self-limited 1.
Contact lens wearers: These patients are at higher risk for complications and may require more aggressive treatment 1.
Duration of therapy: Complete the full course of antibiotics even if symptoms improve to prevent recurrence and resistance development.