Should I use fusithalmic (fusidic acid) eyedrops or ointment for bacterial conjunctivitis?

Fusidic Acid Eyedrops vs. Ointment for Bacterial Conjunctivitis

For bacterial conjunctivitis, fusidic acid eyedrops (Fucithalmic) are preferred over ointment due to better compliance, convenience of twice-daily dosing, and equivalent clinical efficacy. 1

Treatment Recommendations

Mild Bacterial Conjunctivitis

• Fusidic acid 1% viscous eyedrops administered twice daily for 7 days is effective for mild bacterial conjunctivitis 1
• The recommended dosing regimen is:
  • Days 1-2: One to two drops every 2-4 hours in the affected eye(s)
  • Days 3-7: One to two drops four times daily 2
• Mild bacterial conjunctivitis is often self-limiting in immunocompetent adults, but treatment reduces transmissibility and allows earlier return to school/work 3

Moderate to Severe Bacterial Conjunctivitis

• For moderate to severe cases with copious purulent discharge, pain, and marked inflammation:
  • Consider obtaining conjunctival cultures before initiating therapy, especially if gonococcal infection is suspected 3
  • More frequent administration may be required initially 2
• Patients should be advised to return for follow-up in 3-4 days if no improvement is noted 3

Evidence Supporting Fusidic Acid Eyedrops

• Clinical success rates with fusidic acid eyedrops range from 84-93% in controlled trials 4, 5
• Fusidic acid viscous eyedrops have shown equivalent clinical and bacteriological efficacy compared to tobramycin 0.3% drops, but with significantly better compliance, especially in younger patients (85% vs. 47%) 1
• Patients rate fusidic acid eyedrops as more convenient than alternatives requiring more frequent administration 1
• The viscous formulation provides sustained release, allowing for less frequent dosing 5

Advantages of Eyedrops over Ointment

• Eyedrops provide better corneal penetration than ointments, which lack solubility and therefore have limited therapeutic penetration into the cornea 3
• Ointments may be useful as adjunctive therapy or at bedtime in less severe cases, but are not preferred as primary therapy 3
• The viscous eyedrop formulation combines the advantages of drops (better penetration) with longer contact time 1, 6

Special Considerations

• Fusidic acid is particularly effective against Staphylococcal infections, which are common causes of bacterial conjunctivitis 6
• It may be less effective against Streptococcus or Haemophilus species 6
• Side effects are minimal, with only about 5% of patients reporting minor issues like stinging or local discomfort 4

Follow-up Recommendations

• Patients should be advised to return for follow-up if symptoms do not improve within 3-4 days 3
• The frequency of follow-up visits should be based on the severity of disease and treatment used 3
• At follow-up visits, an interval history, visual acuity measurement, and slit-lamp biomicroscopy should be performed 3

Cautions and Pitfalls

• Be alert for methicillin-resistant S. aureus (MRSA), which has been isolated with increasing frequency in bacterial conjunctivitis 3
• Consider obtaining cultures in cases that don't respond to initial therapy 3
• Ensure patients understand the importance of completing the full course of treatment to prevent recurrence 1
• For contact lens wearers, discontinue lens wear during the infection period 3