Treatment of Bacterial Conjunctivitis in a 14-Year-Old
For bacterial conjunctivitis in a 14-year-old, a 5- to 7-day course of broad-spectrum topical antibiotic applied 4 times daily is the recommended treatment. 1
First-Line Treatment
- A broad-spectrum topical antibiotic should be applied 4 times daily for 5-7 days, with the most convenient or least expensive option being appropriate as there is no clinical evidence suggesting superiority of any particular antibiotic 1
- Common effective options include:
- Fluoroquinolones (moxifloxacin, gatifloxacin) which are effective against common pathogens including Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae 2, 3
- Polymyxin-bacitracin ointment, which has been shown to significantly improve clinical cure rates (62% vs 28% with placebo by days 3-5) 4
Treatment Algorithm Based on Severity
Mild Bacterial Conjunctivitis
- Characterized by minimal discharge and mild redness
- Topical antibacterial therapy is associated with earlier clinical and microbiological remission, reduced transmissibility, and earlier return to school 1
- While mild bacterial conjunctivitis may resolve spontaneously, treatment accelerates recovery and reduces transmission 5
Moderate to Severe Bacterial Conjunctivitis
- Characterized by copious purulent discharge, pain, and marked inflammation
- Requires more aggressive treatment approach 1
- Consider obtaining conjunctival cultures before starting treatment if severe or if gonococcal infection is suspected 6
- For severe cases, consider referral to an ophthalmologist, especially if there is:
- Visual loss
- Moderate or severe pain
- Severe purulent discharge
- Corneal involvement
- Lack of response to therapy 6
Special Considerations
- If gonococcal infection is suspected (extremely purulent discharge), systemic antibiotic therapy is necessary in addition to topical treatment 6
- For a 14-year-old with gonococcal conjunctivitis weighing ≥45 kg: Ceftriaxone 125 mg IM, single dose 6
- For a 14-year-old with chlamydial conjunctivitis ≥8 years: Azithromycin 1 g orally, single dose or Doxycycline 100 mg orally, twice daily for 7 days 6
- Sexual abuse should be considered in children with gonococcal or chlamydial infections 6
Follow-Up Recommendations
- Patients should be advised to return for evaluation in 3-4 days if they note no improvement 6
- For gonococcal conjunctivitis, daily follow-up is recommended until resolution 6
- For other types of bacterial conjunctivitis, clinical improvement should be seen within 3-5 days of starting treatment 4
Patient Education
- Hand washing is important to reduce the risk of transmission 6
- Avoid sharing towels, pillows, and close contact with others during the period of contagion 6
- Patients can generally return to school once treatment has been initiated for 24 hours and symptoms begin to improve 6
Common Pitfalls and Caveats
- Increasing bacterial resistance is a concern, particularly with methicillin-resistant S. aureus (MRSA) 1
- If no improvement is seen after 3-4 days of treatment, consider alternative diagnoses or resistant organisms 6
- Viral conjunctivitis is often misdiagnosed as bacterial conjunctivitis, leading to unnecessary antibiotic use 5
- Contact lens wearers with conjunctivitis should be referred to an ophthalmologist due to higher risk of complications 6