From the Guidelines
The treatment of choice for mild to moderate bacterial conjunctivitis is a 5- to 7-day course of a broad-spectrum topical antibiotic, as it is associated with earlier clinical and microbiological remission compared to placebo 1. When selecting a topical antibiotic, the most convenient or least expensive option can be chosen, as there is no clinical evidence suggesting the superiority of any particular antibiotic 1. Some commonly used broad-spectrum topical antibiotics for bacterial conjunctivitis include:
- Erythromycin ointment
- Polymyxin B-trimethoprim drops
- Fluoroquinolones like moxifloxacin or ciprofloxacin The typical regimen involves applying drops 4 times daily or ointment 2-3 times daily for 5-7 days, even if symptoms resolve earlier to ensure complete eradication of the infection. It's also important to note that povidone-iodine 1.25% ophthalmic solution may be as effective as topical antibiotic therapy for treating bacterial conjunctivitis and could be considered when access to antibiotics is limited 1. In addition to antibiotic treatment, patients should:
- Temporarily discontinue contact lens wear until the infection resolves completely
- Gently clean away any discharge with warm water and a clean cloth before applying medication
- Apply medication as directed, even if symptoms resolve earlier, to ensure complete eradication of the infection.
From the FDA Drug Label
Moxifloxacin ophthalmic solution, 0.5% is indicated for the treatment of bacterial conjunctivitis caused by susceptible strains of the following organisms:
Moxifloxacin ophthalmic solution is for topical ophthalmic use.
Instill one drop in the affected eye 3 times a day for 7 days.
The treatment of choice for mild to moderate bacterial conjunctivitis is moxifloxacin ophthalmic solution, 0.5%, administered as one drop in the affected eye 3 times a day for 7 days 2.
From the Research
Treatment Options for Mild to Moderate Bacterial Conjunctivitis
- The treatment of choice for mild to moderate bacterial conjunctivitis is a broad-spectrum antibiotic, with fluoroquinolones being a popular option 3, 4, 5.
- Moxifloxacin 0.5% ophthalmic solution has been shown to be effective in the treatment of bacterial conjunctivitis, with good activity against various Gram-positive and -negative ocular isolates 4, 5.
- Gatifloxacin 0.5% ophthalmic solution administered twice daily for 5 days has also been found to be safe and effective for the treatment of acute bacterial conjunctivitis 6.
- Other antibiotics such as gentamycin, tobramycin, and azithromycin may be preferred in some cases, and delayed topical antibiotics or treatment without antibiotics using artificial tears and eye bathings may be considered in mild cases 7.
Factors Influencing Treatment Choice
- The development of resistance to antibiotics is a concern, and fluoroquinolones should be saved for severe infections due to their broad spectrum of activity 3, 7.
- The choice of antibiotic may depend on the severity of the infection, the patient's age and health status, and the presence of any underlying conditions 5, 7.
- Topical antibiotics are generally preferred over systemic antibiotics for the treatment of bacterial conjunctivitis, as they provide high concentrations of the antibiotic at the site of infection and minimize systemic side effects 4, 5, 6.