What eye ointment is recommended for bacterial conjunctivitis?

Treatment of Bacterial Conjunctivitis

Topical broad-spectrum antibiotics are recommended for bacterial conjunctivitis as they reduce symptom duration, improve clinical outcomes, and allow earlier return to school/work. 1

First-Line Treatment Options

• Fluoroquinolones (ciprofloxacin 0.3%, ofloxacin 0.3%, levofloxacin 1.5%) are FDA-approved for bacterial conjunctivitis and have been shown to be effective as single-drug therapy 2
• Fourth-generation fluoroquinolones (moxifloxacin, gatifloxacin) have better coverage of gram-positive pathogens than earlier generation fluoroquinolones, though they are not FDA-approved specifically for bacterial conjunctivitis 2
• Erythromycin ophthalmic ointment is effective and should be applied directly to the infected eye(s) up to six times daily, depending on the severity of the infection 3

Treatment Approach Based on Severity

• For mild bacterial conjunctivitis: A 5-7 day course of broad-spectrum topical antibiotic accelerates clinical and microbiological remission and reduces transmissibility 1
• For moderate to severe bacterial conjunctivitis: Obtain conjunctival cultures and Gram staining before initiating treatment, especially if gonococcal infection is suspected 1
• For central or severe keratitis: A loading dose (every 5-15 minutes) followed by frequent applications (every hour) is recommended 2

Special Considerations

• Gonococcal conjunctivitis requires systemic antibiotic therapy rather than topical treatment alone, with saline lavage to promote comfort and faster resolution 1
• Chlamydial conjunctivitis requires systemic antibiotic therapy, especially in infants who may have infection at other sites 1
• Ointments may be useful at bedtime in less severe cases and for adjunctive therapy, though they have limited corneal penetration 2
• Cycloplegic agents may be used to decrease synechiae formation and reduce pain from anterior segment inflammation 2

Administration Guidelines

• Apply approximately 1 cm of ointment directly to the infected eye(s) 3
• For drops, frequency depends on severity - from twice daily for mild cases to hourly for severe cases 2, 1
• Studies show bacteria are cleared in 7 days in self-limiting cases, but a 7-day course of antibiotics has been shown to eradicate bacteria within 5 days 2

Potential Pitfalls and Considerations

• Bacterial resistance is a growing concern, particularly with MRSA infections 1
• Poor adherence to frequent administration regimens can contribute to treatment failure 4
• Individual risk factors for fluoroquinolone resistance include recent fluoroquinolone use, hospitalization, age, and recent ocular surgery 2
• Return for follow-up if no improvement after 3-4 days of treatment 1
• Indiscriminate use of topical antibiotics should be avoided as viral conjunctivitis will not respond to antibacterial agents 2

Most Common Pathogens

• Haemophilus influenzae and Streptococcus pneumoniae are the most prevalent bacteria in pediatric bacterial conjunctivitis 5
• Staphylococcus aureus, Staphylococcus epidermidis, and Moraxella species are also common pathogens 4

Patient Education

• Educate patients about proper hygiene to break the chain of transmission 2
• Infected individuals should wash hands frequently, use separate towels, and avoid close contact with others during the period of contagion (10-14 days from onset) 2