What is the recommended treatment for a patient with bacterial conjunctivitis (pink eye)?

Treatment of Bacterial Conjunctivitis (Pink Eye)

For bacterial conjunctivitis, a 5-7 day course of broad-spectrum topical antibiotic applied 4 times daily is the recommended treatment as it accelerates clinical and microbiological remission, reduces transmissibility, and allows earlier return to school/work. 1

First-Line Treatment Options

• Fluoroquinolones (e.g., moxifloxacin, gatifloxacin) are effective against common bacterial pathogens and are recommended as first-line therapy 1, 2
• Aminoglycosides (e.g., tobramycin) are also effective options for bacterial conjunctivitis 2
• Sulfacetamide sodium 10% ophthalmic solution is indicated for bacterial conjunctivitis due to susceptible organisms including Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae 3

Dosing Recommendations

• For most topical antibiotics: Apply 1-2 drops into the affected eye(s) every 2-3 hours initially, then taper by increasing the interval between doses as the condition improves 3
• Sulfacetamide sodium: Instill 1-2 drops into the conjunctival sac of the affected eye(s) every 2-3 hours initially, with tapering as the condition responds 3
• Bacitracin ophthalmic ointment: Apply directly into the conjunctival sac 1-3 times daily 4
• Standard treatment duration is 5-7 days 1, 3

Monitoring Response to Treatment

Several clinical features suggest a positive response to antibiotic therapy:

• Reduced pain and discharge 5
• Lessened eyelid edema and conjunctival injection 5
• Reduced anterior chamber inflammation 5

Special Considerations

• For gonococcal or chlamydial conjunctivitis, systemic antibiotic therapy is required rather than topical treatment alone 1, 2
• Obtain conjunctival cultures and Gram staining before initiating treatment in moderate to severe cases, especially if gonococcal infection is suspected 1, 2
• Avoid using topical corticosteroids unless under close supervision, as they may prolong bacterial shedding and worsen infection 2

Follow-Up Recommendations

• Advise patients to return for follow-up if no improvement is seen after 3-4 days of treatment 1, 2
• Follow-up should include interval history, visual acuity measurement, and slit-lamp biomicroscopy 1
• If there is persistent epithelial defect but the infection is under control, consider adjunctive therapies such as lubrication, bandage contact lens, or tarsorrhaphy 5

When to Refer to an Ophthalmologist

• Visual loss, moderate or severe pain, severe purulent discharge 2
• Corneal involvement, conjunctival scarring 2
• Lack of response to therapy or recurrent episodes 1, 2

Prevention of Transmission

• Advise patients about hygiene measures including frequent handwashing and avoiding sharing of personal items like towels, pillowcases, and makeup 6
• Patients should avoid touching their eyes to prevent spread of infection 6

Pitfalls to Avoid

• Bacterial resistance is a growing concern, particularly with MRSA infections 1, 7
• Poor adherence to frequent administration regimens can contribute to treatment failure 1
• Most antibiotic eye drops should not be tapered below 3-4 times daily because low doses are subtherapeutic and may increase the risk of developing antibiotic resistance 5