What is the treatment (Tx) for bacterial conjunctivitis?

Treatment of 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, and moxifloxacin 0.5% ophthalmic solution. 1

Diagnosis and Classification

Before initiating treatment, it's important to identify bacterial conjunctivitis, which 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 daily for 7 days 2
  • Ciprofloxacin ophthalmic solution: One or two drops every 2 hours while awake for 2 days, then every 4 hours while awake for 5 days 3
  • Azithromycin ophthalmic solution: One drop twice daily (8-12 hours apart) for 2 days, then once daily for 5 days 4

Supportive Measures

• Warm compresses to soften discharge and loosen crusts 1
• Strict hygiene measures to prevent spread 1

Special Situations

1. Gonococcal conjunctivitis: Requires both systemic (ceftriaxone) and topical therapy 1
2. Chlamydial conjunctivitis: Requires systemic therapy (azithromycin, doxycycline, or levofloxacin) 1
3. Neonatal conjunctivitis: Immediate referral to ophthalmology 1

Indications for Ophthalmology Referral

Refer patients with:

• No response to therapy after 3-4 days
• Moderate to severe pain
• Visual loss
• Corneal involvement
• Conjunctival scarring
• Recurrent episodes
• History of herpes simplex virus eye disease
• Immunocompromised status 1

Efficacy and Course

• 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 infection, reducing risk of complications and spread 1
• Studies show that by day 3-5,62% of patients receiving topical antibiotics were clinically cured versus only 28% in the placebo group 5

Prevention and Control

• Frequent handwashing
• Separate towels and washcloths
• Avoid sharing pillowcases
• Proper disinfection of toys and surfaces 1
• Contact lens wearers should discontinue lens wear until infection resolves 1

Important Considerations and Pitfalls

1. Antibiotic resistance: Increasing resistance to fluoroquinolones has been reported, particularly in MRSA isolates. Consider local resistance patterns when selecting antibiotics 1

2. Avoid indiscriminate use: Viral conjunctivitis will not respond to antibacterial agents, and mild bacterial conjunctivitis is often self-limited 1

3. Contact lens wearers: Consider switching to new lenses after resolution to prevent re-infection 1

4. Delayed prescribing: May be considered for mild cases as it has similar symptom control as immediate prescribing 1

5. Moxifloxacin contraindications: History of hypersensitivity to moxifloxacin, other quinolones, or components of the medication 2