What topical antibiotic is recommended for a stye?

Topical Antibiotic Treatment for Stye (Hordeolum)

For styes (hordeolum), topical bacitracin or erythromycin ointment applied to the eyelid margins is the recommended topical antibiotic treatment when warm compresses and eyelid hygiene fail to resolve the condition after 2-4 weeks. 1

First-Line Management (Non-Antibiotic)

• Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily to soften crusts, warm meibomian secretions, and promote drainage 1
• Clean the eyelid margin using diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip once or twice daily 1
• Perform gentle vertical massage of the eyelid for posterior blepharitis/meibomian gland involvement to help express secretions 1

Topical Antibiotic Treatment (When First-Line Fails)

• Bacitracin or erythromycin ointment should be applied to the eyelid margins one or more times daily for a few weeks 1
• Mupirocin 2% topical ointment is an alternative option for minor skin infections and secondarily infected skin lesions 2
• The frequency and duration of antibiotic treatment should be guided by the severity of the condition and response to treatment 1

Considerations for Topical Antibiotic Selection

• Bacitracin has a narrow antibacterial spectrum targeting gram-positive organisms commonly associated with styes 3
• Mupirocin has shown effectiveness against staphylococcal infections, which are common causative organisms in styes 3
• Topical triple-antibiotic ointments (containing neomycin, polymyxin, and bacitracin) have demonstrated superior eradication of resident bacteria compared to single agents 4
• Antibiotic drops placed in the conjunctival cul-de-sac appear to be as effective as ointment applied directly to the lid margins in reducing bacterial colonization 5

For Persistent or Severe Cases

• If topical antibiotics fail to resolve the stye, oral antibiotics may be considered 1
• For adults, doxycycline, minocycline, or tetracycline may be used 1
• For children under 8 years or pregnant women, erythromycin is the preferred oral antibiotic as tetracyclines are contraindicated 1, 6

Important Precautions

• Avoid aggressive manipulation of the eyelid, particularly in patients with advanced glaucoma 1
• Be aware that topical use of bacitracin may occasionally produce treatment failure and sensitization in some patients 3
• Patients should be advised that warm compress and eyelid cleansing treatment may be required long-term, as symptoms often recur when treatment is discontinued 1

When to Consider Referral

• If the stye does not respond to topical antibiotics after 2 weeks of treatment 1
• If there are signs of systemic illness or extensive infection 2
• If the stye is in an area difficult to treat (e.g., inner eyelid) 2