What antibiotics are used to treat a stye (hordeolum)?

Stye Antibiotic Treatment

For uncomplicated styes (hordeola), topical antibiotic ointment such as bacitracin or erythromycin applied directly to the eyelid margin is recommended only if the stye persists beyond 1-2 weeks or worsens despite conservative treatment with warm compresses and eyelid hygiene. 1, 2

Initial Conservative Management (First-Line)

• Apply warm compresses to the affected eyelid for 5-10 minutes, 3-4 times daily to promote spontaneous drainage 2
• Perform gentle eyelid cleansing using diluted baby shampoo or commercial eyelid cleaner once or twice daily to remove debris 2
• Most styes resolve spontaneously within 1-2 weeks with conservative measures alone 1

When to Add Topical Antibiotics (Second-Line)

• If the stye persists beyond 1-2 weeks or worsens despite conservative treatment, apply bacitracin or erythromycin ointment directly to the eyelid margin where lashes emerge 1, 2, 3
• Apply approximately 1 cm ribbon to the eyelid margin (not into the conjunctival sac) 1-4 times daily, adjusting frequency based on severity 1, 4
• Continue treatment for a few weeks, then reassess clinical response 1, 4
• Mupirocin 2% ointment is an alternative option for minor skin infections 2

When Systemic Antibiotics Are Needed

• For recurrent or severe styes not responding to topical treatment, consider oral antibiotics such as cephalexin or dicloxacillin for deeper infection 1
• In children under 8 years or pregnant women, use oral erythromycin instead of tetracyclines to avoid tooth staining 1, 2
• Alternative oral antibiotics include azithromycin for women of childbearing age and children 2
• For suspected MRSA infection with spreading cellulitis, consider trimethoprim-sulfamethoxazole or doxycycline/minocycline, though treatment failure rates up to 21% have been reported with tetracyclines 2
• Patients started on oral antibiotics should be reevaluated in 24-48 hours to verify clinical response 2

Treatment Duration

• Most bacterial skin and soft tissue infections should be treated for 7-14 days 5
• Topical antibiotic treatment can be repeated intermittently, rotating different antibiotics to prevent resistant organisms 1, 4

Critical Pitfalls to Avoid

• Never apply ointment into the conjunctival sac when treating styes—the target is the eyelid margin where bacterial colonization occurs 1, 4
• Do not use corticosteroid drops for an active stye, as steroids can worsen bacterial infections and are only indicated after infection is controlled 1
• Avoid aggressive manipulation or squeezing of the stye, as this can spread infection 1
• In patients with advanced glaucoma, avoid aggressive lid pressure during warm compress application to prevent increased intraocular pressure 1, 2

When to Consider Surgical Intervention

• If there is no improvement after appropriate antibiotic therapy, incision and drainage is recommended as the next step 2
• If signs of orbital cellulitis or systemic illness develop, immediate referral to ophthalmology is necessary 2