Antibiotic Treatment for Stye (Hordeolum)
For styes (hordeola), topical antibiotic ointments such as bacitracin or erythromycin applied to the eyelid margins one or more times daily or at bedtime for a few weeks are the recommended first-line antibiotic treatment. 1
First-Line Treatment Approach
- Begin with warm compresses and eyelid hygiene, which are essential first steps before antibiotic therapy 1, 2
- Apply topical antibiotic ointment such as bacitracin or erythromycin to eyelid margins after cleansing 1
- These topical antibiotics can provide symptomatic relief and effectively decrease bacteria from the eyelid margin 1
- The frequency and duration of treatment should be guided by the severity of the stye and response to treatment, typically for a few weeks 1
- Consider rotating different antibiotics to prevent the development of resistant organisms 2
When to Consider Oral Antibiotics
- For styes that don't respond to topical treatment or are associated with more extensive infection, oral antibiotics may be necessary 1, 3
- Oral antibiotics are recommended for styes with the following conditions 1:
- Severe or extensive disease involving multiple sites
- Rapid progression with associated cellulitis
- Signs and symptoms of systemic illness
- Associated comorbidities or immunosuppression
- Extremes of age
- Location in an area difficult to drain (e.g., face)
- Lack of response to topical treatment
Oral Antibiotic Options
For adults with styes not responding to topical treatment, oral antibiotic options include 1:
- Clindamycin (300-450 mg four times daily)
- Cephalexin (250-500 mg four times daily)
- Doxycycline (100 mg twice daily)
- Minocycline (100 mg twice daily)
- Trimethoprim-sulfamethoxazole (1-2 double-strength tablets twice daily)
For children or pregnant women, avoid tetracyclines and consider alternatives like erythromycin or azithromycin 1, 2
Important Considerations and Limitations
- Despite common use of antibiotics for styes, there is limited high-quality evidence supporting their effectiveness 4, 5
- No randomized controlled trials specifically evaluating antibiotic treatment for acute internal hordeolum were identified in systematic reviews 4, 5
- Topical antibiotics should be used judiciously to prevent development of resistance 6
- Styes often resolve spontaneously within 7-10 days with warm compresses alone 4
- If the stye does not improve with conservative treatment and antibiotics, or if it recurs frequently, consider referral to an ophthalmologist for possible incision and drainage 1
Special Populations
- For children under 8 years of age, tetracyclines should not be used due to risk of teeth staining 1
- For pregnant women, macrolides like erythromycin are preferred over tetracyclines 1
- In patients with advanced glaucoma, advise against aggressive pressure on the eyelids during warm compress application 1