What is the recommended treatment for bacterial conjunctivitis?

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/work. 1

Treatment Approach Based on Severity

Mild Bacterial Conjunctivitis

• Apply a broad-spectrum topical antibiotic 4 times daily for 5-7 days 2
• Topical antibiotics are recommended even for mild cases as they reduce symptom duration and improve clinical outcomes 1
• Common effective antibiotics include fluoroquinolones (e.g., gatifloxacin, moxifloxacin), gentamicin, and tetracycline 1
• For gatifloxacin specifically: Instill one drop every two hours while awake (up to 8 times) on Day 1, then 2-4 times daily on Days 2-7 3

Moderate to Severe Bacterial Conjunctivitis

• Obtain conjunctival cultures and Gram staining before initiating treatment, especially if gonococcal infection is suspected 1
• More aggressive treatment approach is required for cases with copious purulent discharge, pain, and marked inflammation 2
• Consider referral to an ophthalmologist for severe cases with vision loss, severe pain, or corneal involvement 4

Special Considerations

Gonococcal Conjunctivitis

• Requires systemic antibiotic therapy rather than topical treatment alone 1
• Add saline lavage to promote comfort and faster resolution of inflammation 1
• Daily follow-up is recommended until resolution 4

Chlamydial Conjunctivitis

• Requires systemic antibiotic therapy, especially in infants who may have infection at other sites 1
• For neonates with chlamydial conjunctivitis, oral erythromycin base or ethylsuccinate 50 mg/kg/day divided into four doses daily for 14 days is recommended 1

MRSA Infections

• Vancomycin may be required for methicillin-resistant S. aureus (MRSA) infections 1
• Compounded topical antibiotics may be necessary for resistant organisms 2

Alternative Treatment Options

• Povidone-iodine 1.25% ophthalmic solution may be as effective as topical antibiotics and can be considered when access to antibiotics is limited 1, 2

Follow-up Care

• Patients should return for evaluation if no improvement is noted after 3-4 days of treatment 4
• Consider resistant organisms or reevaluate the diagnosis if treatment is not effective after 3-4 days 4

Patient Education

• Hand washing is important to reduce the risk of transmission 4
• Avoid sharing towels, pillows, and close contact with others during the contagious period 4
• Patients can generally return to school or work once treatment has been initiated for 24 hours and symptoms begin to improve 4
• Advise patients not to wear contact lenses during the course of therapy 3

Common Pitfalls and Caveats

• Bacterial resistance is a growing concern, particularly with MRSA infections 1
• Poor adherence to frequent administration regimens can contribute to treatment failure 1
• Consider sexual abuse in children with gonococcal or chlamydial conjunctivitis 1
• Prolonged use of antibiotics may result in overgrowth of nonsusceptible organisms, including fungi 3
• Most common pathogens include Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella species 5, 6