Treatment of Bacterial Conjunctivitis
For bacterial conjunctivitis, a 5-7 day course of broad-spectrum topical antibiotic is recommended as it accelerates clinical and microbiological remission, reduces transmissibility, and allows earlier return to school or work. 1
First-Line Treatment Approach
- For mild to moderate bacterial conjunctivitis, apply a broad-spectrum topical antibiotic 4 times daily for 5-7 days 1, 2
- Fluoroquinolones (e.g., moxifloxacin, gatifloxacin) are effective against common pathogens and are recommended by the World Health Organization 1
- For gatifloxacin specifically, instill one drop every two hours in the affected eye(s) while awake (up to 8 times) on Day 1, then one drop 2-4 times daily on Days 2-7 3
- Most cases of bacterial conjunctivitis are self-limiting, but antibiotic treatment shortens duration and reduces transmission 2, 4
Treatment Based on Severity
- For mild bacterial conjunctivitis, the most convenient or least expensive broad-spectrum antibiotic is appropriate as there is no clinical evidence suggesting superiority of any particular agent 2
- For moderate to severe cases with copious purulent discharge, obtain conjunctival cultures and Gram staining before initiating treatment 1
- Ciprofloxacin, chloramphenicol, and rifampin have shown good activity against the most prevalent pathogens (Haemophilus influenzae and Streptococcus pneumoniae) 5
Special Considerations
- Gonococcal conjunctivitis requires systemic antibiotic therapy rather than topical treatment alone, with saline lavage to promote comfort 1
- Chlamydial conjunctivitis requires systemic antibiotic therapy, especially in infants who may have infection at other sites 1
- For methicillin-resistant S. aureus (MRSA) infections, vancomycin may be required 6, 2
- Povidone-iodine 1.25% ophthalmic solution may be considered when access to antibiotics is limited 1
Follow-up Care
- Advise patients to return for evaluation if no improvement is seen after 3-4 days of treatment 7
- For gonococcal conjunctivitis, daily follow-up is recommended until resolution 7
- Most uncomplicated cases of bacterial conjunctivitis resolve in 1-2 weeks 4
Prevention of Transmission
- Instruct patients on proper hand washing to reduce transmission risk 7
- Advise patients to avoid sharing towels, pillows, and close contact with others during the contagious period 7
- Patients can generally return to school or work after 24 hours of treatment when symptoms begin to improve 7
Common Pitfalls and Caveats
- Increasing bacterial resistance is a concern, particularly with MRSA infections 2
- Never use topical antibiotics containing corticosteroids unless the conjunctivitis is proven to be non-herpetic 8
- For children with gonococcal or chlamydial infections, consider the possibility of sexual abuse 2
- Contact lens wearers should be advised not to wear lenses during the course of treatment 3