What is the recommended treatment for bacterial conjunctivitis in adults?

Treatment of Bacterial Conjunctivitis in Adults

For mild bacterial conjunctivitis in adults, prescribe a 5-7 day course of broad-spectrum topical antibiotic applied 4 times daily, with fluoroquinolones (moxifloxacin, gatifloxacin) or aminoglycosides (tobramycin) being effective first-line options. 1, 2

First-Line Treatment Approach

• Topical antibiotics are recommended even for mild cases as they accelerate clinical and microbiological remission by days 2-5, reduce transmissibility, and allow earlier return to work 1, 2

• The most convenient or least expensive broad-spectrum option is appropriate, as there is no clinical evidence suggesting superiority of any particular antibiotic for uncomplicated cases 2

• Fluoroquinolones are highly effective options:

  • Moxifloxacin 0.5% ophthalmic solution is FDA-approved for bacterial conjunctivitis, dosed one drop in the affected eye 3 times daily for 7 days 3
  • Gatifloxacin ophthalmic solution is also FDA-approved with similar efficacy 4
  • These agents achieve excellent ocular tissue penetration and cover common pathogens including Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae 5, 3

• Alternative effective options include:

  • Aminoglycosides (tobramycin) 1, 6
  • Polymyxin B/trimethoprim 1
  • Povidone-iodine 1.25% ophthalmic solution may be as effective as topical antibiotics when access is limited 1, 2

Moderate to Severe Cases

• Obtain conjunctival cultures and Gram staining before initiating treatment if you observe copious purulent discharge, marked inflammation, or severe pain 1, 2, 6

• Compounded topical antibiotics such as vancomycin may be required for resistant organisms like MRSA 2

• Consider MRSA if standard therapy fails, as bacterial resistance is an increasing concern 1, 2

Critical Special Situations Requiring Different Management

Gonococcal Conjunctivitis

• Requires systemic antibiotic therapy, not topical treatment alone 1, 2, 6
• Add saline lavage to promote comfort and faster resolution 1
• Daily follow-up is mandatory until resolution 2

Chlamydial Conjunctivitis

• Requires systemic antibiotic therapy rather than topical treatment 1, 2, 6
• Follow-up evaluation is important as treatment failure occurs in up to 19% of cases 2

Follow-Up and Red Flags

• Instruct patients to return if no improvement after 3-4 days of treatment 1, 6

• Refer to ophthalmology immediately for:

  • Visual loss or moderate to severe pain 1, 6
  • Severe purulent discharge or corneal involvement 1, 6
  • Conjunctival scarring 1, 6
  • Lack of response to therapy or recurrent episodes 1, 6

Important Pitfalls to Avoid

• Do not use topical corticosteroids unless under close ophthalmologic supervision, as they may prolong bacterial shedding and worsen infection 6

• Advise patients not to wear contact lenses during treatment 3

• Emphasize strict hand hygiene and avoiding sharing personal items to prevent transmission 6

• Be aware that increasing bacterial resistance, particularly MRSA, is a growing concern that may require alternative antibiotics 1, 2

• Poor adherence to frequent dosing regimens contributes to treatment failure 1