Treatment of Streptococcal Conjunctivitis
For conjunctivitis caused by streptococcal infection, a 5-7 day course of broad-spectrum topical antibiotics applied 4 times daily is the recommended first-line treatment. 1, 2
Diagnosis and Initial Assessment
- Streptococcal conjunctivitis typically presents with marked inflammation, purulent discharge, and sometimes pain 1
- Consider obtaining conjunctival cultures and Gram staining before initiating treatment, especially in moderate to severe cases 1
- Examine for swollen preauricular or submandibular lymph nodes, which may indicate bacterial infection 3
Treatment Recommendations
First-Line Treatment
- Broad-spectrum topical antibiotics for 5-7 days with application 4 times daily 1, 2
- Fluoroquinolones (e.g., moxifloxacin, gatifloxacin) are effective against common pathogens including Streptococcus species 1, 4
- Aminoglycosides like tobramycin are also effective options 1
- Treatment should continue for at least 10 days for Streptococcus pyogenes infections to prevent acute rheumatic fever 5
Alternative Options
- Povidone-iodine 1.25% ophthalmic solution may be considered when access to antibiotics is limited 1, 2
- For severe cases or treatment failures, consider systemic antibiotics in addition to topical therapy 1
Special Considerations
- Patients should be advised to return for follow-up if no improvement is seen after 3-4 days of treatment 1, 2
- Topical antibiotics have been shown to shorten clinical disease duration and enhance eradication of causative organisms 6
- Avoid using topical corticosteroids unless under close supervision, as they may prolong bacterial shedding and worsen infection 3
- For severe inflammation with marked chemosis or eyelid swelling, topical corticosteroids may be considered but require close follow-up 3
Patient Education
- Bacterial conjunctivitis is highly contagious; advise patients about hygiene measures to prevent spread 3
- Instruct patients to avoid sharing towels, pillowcases, and makeup 1
- Patients should wash hands frequently and avoid touching their eyes 1
- Compliance with the full course of antibiotics is important to prevent recurrence and antibiotic resistance 7
Follow-Up Recommendations
- Schedule follow-up within 1 week for severe cases with corneal involvement or membranous conjunctivitis 3
- For mild cases, instruct patients to return if symptoms persist beyond 2-3 weeks 3
- Follow-up should include interval history, visual acuity measurement, and slit-lamp biomicroscopy 3
Pitfalls and Caveats
- Bacterial resistance is a growing concern, particularly with MRSA infections 1, 7
- Poor adherence to frequent administration regimens can contribute to treatment failure 1
- Never use antibiotics with corticosteroid components unless the conjunctivitis is proven to be non-herpetic 8
- Avoid relying on oral antibiotics alone for severe ocular infections, as absorption may be inadequate 9