From the Guidelines
Resistant bacterial conjunctivitis is typically treated with prolonged use of systemic anti-staphylococcal antibiotics and intensive topical antibiotics and corticosteroids.
Treatment Strategies
- Prolonged use of systemic anti-staphylococcal antibiotics
- Intensive topical antibiotics and corticosteroids
- Supratarsal injections of antibiotics and corticosteroids, along with irrigation and sweeping of the fornix with povidone-iodine solution 1
Considerations
- Conjunctival cultures before starting treatment can help guide the appropriate choice of antibiotic, especially with the increasing frequency of methicillin-resistant S. aureus (MRSA) in the general population 1
- Microbiology laboratory testing may guide therapy, which may include compounded topical antibiotics such as vancomycin 1
- Surgical correction of ptosis may be helpful in some cases 1
From the Research
Treatment for Resistant Bacterial Conjunctivitis
- The treatment for resistant bacterial conjunctivitis is a concern due to the increasing development of bacterial resistance to antibiotics 2, 3, 4.
- Topical antibiotics are commonly used to treat bacterial conjunctivitis, but the choice of antibiotic should be guided by the susceptibility of the causative organism 5, 6.
- Fluoroquinolones, such as besifloxacin, have been shown to be effective in treating bacterial conjunctivitis, but their use should be reserved for severe infections due to their broad-spectrum activity 3, 4.
- Other antibiotics, such as gentamycin, tobramycin, and azithromycin, may be preferred for the treatment of bacterial conjunctivitis due to their effectiveness and lower risk of resistance 4.
- In some cases, treatment without antibiotics using artificial tears and eye bathings may be considered, especially in cases of mild conjunctivitis or where the infection is self-limiting 5, 4.
Antibiotic Resistance
- Antibiotic resistance is a significant concern in the treatment of bacterial conjunctivitis, with many common pathogens showing resistance to multiple antibiotics 2, 3, 6.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a particular concern, as it has been isolated with increasing frequency in recent years 4.
- The development of resistance to fluoroquinolones, such as ciprofloxacin, is also a concern, as these antibiotics are commonly used to treat bacterial conjunctivitis 3, 6.
Specific Pathogens
- Haemophilus influenzae and Streptococcus pneumoniae are the most common causes of bacterial conjunctivitis, and their antibiotic susceptibility profiles should guide treatment choices 5, 3, 6.
- Staphylococcus aureus, including MRSA, is also a common cause of bacterial conjunctivitis, and its treatment requires careful consideration of antibiotic resistance patterns 2, 4.