What is the recommended treatment for bacterial conjunctivitis using Cravit (levofloxacin) eyedrop?

Cravit (Levofloxacin) Eyedrop for Bacterial Conjunctivitis

For bacterial conjunctivitis, Cravit (levofloxacin 0.5% or 1.5%) should be administered as 1-2 drops every 2 hours while awake on days 1-2, then every 4 hours while awake on days 3-5 for a total 5-7 day course. 1, 2

Dosing Regimen

Standard Bacterial Conjunctivitis (Mild to Moderate)

• Instill 1-2 drops in the affected eye(s) every 2 hours while awake on days 1-2 1
• Continue with 1-2 drops every 4 hours while awake on days 3-5 1
• Total treatment duration is 5-7 days 2

Severe Bacterial Conjunctivitis or Corneal Ulcer

• For corneal ulcers specifically, the FDA-approved levofloxacin 1.5% regimen is more intensive: 1
  • Days 1-3: 1-2 drops every 30 minutes to 2 hours while awake, plus approximately 4 and 6 hours after retiring 1
  • Day 4 through completion: 1-2 drops every 1-4 hours while awake 1

Alternative Simplified Dosing

• Research supports that levofloxacin 0.5% administered three times daily for 5 days achieves comparable clinical cure (85.4%) and microbial eradication rates (92.7%) to the more frequent dosing regimen, with better patient compliance 3

Efficacy and Coverage

• Levofloxacin 0.5% demonstrates superior microbial eradication rates (89-90%) compared to ofloxacin 0.3% (80-81%) at end point 4
• Achieves 90% microbial eradication rates versus placebo in controlled trials 5
• Effective against both gram-positive bacteria (Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Corynebacterium species) and gram-negative bacteria (Pseudomonas aeruginosa, Serratia marcescens) 1
• Levofloxacin 1.5% demonstrated equal efficacy to ofloxacin 0.3% for bacterial keratitis endpoints 6

Important Clinical Considerations

When Topical Therapy Alone is Insufficient

• Gonococcal conjunctivitis requires systemic antibiotic therapy in addition to any topical treatment 2, 7
• Chlamydial conjunctivitis requires systemic antibiotics; topical therapy alone is inadequate 2
• Consider sexual abuse in children presenting with gonococcal or chlamydial conjunctivitis 2

Resistance Patterns

• Increasing fluoroquinolone resistance has been reported, particularly with methicillin-resistant S. aureus (MRSA) 7
• MRSA isolates are generally poorly responsive to fluoroquinolones and may require vancomycin 6, 2
• Resistance patterns vary geographically; consider local antibiograms when available 7

Follow-up Requirements

• Patients should return if no improvement occurs after 3-4 days of treatment 2, 7
• At follow-up, perform visual acuity measurement and slit-lamp biomicroscopy 2
• Consider culture and sensitivity testing if treatment fails 7

Referral Indications to Ophthalmology

• Visual loss 2
• Moderate or severe pain 2
• Severe purulent discharge 2
• Corneal involvement 2
• Conjunctival scarring 2
• Lack of response to therapy 2
• Recurrent episodes 2

Safety Profile

• Well tolerated with low incidence of adverse events 4, 5
• Most common adverse reactions: headache (8-10%) and taste disturbance (8-10%) 1
• Less common reactions (1-2%): decreased/blurred vision, instillation site irritation/discomfort, ocular pain/discomfort 1
• Contraindicated in patients with hypersensitivity to levofloxacin, other quinolones, or any component 1
• Serious hypersensitivity reactions (anaphylaxis) have been reported with systemic quinolones; discontinue immediately if allergic reaction occurs 1

Common Pitfalls

• Do not use contact lenses during treatment of bacterial conjunctivitis 1
• Prolonged use may result in overgrowth of non-susceptible organisms including fungi; discontinue and institute alternative therapy if superinfection occurs 1
• Poor adherence to frequent dosing regimens contributes to treatment failure; consider three-times-daily regimen for better compliance 2, 3
• Do not rely on topical therapy alone for gonococcal or chlamydial conjunctivitis 2