What antibiotics are used to treat a stye?

Antibiotics for Stye (Hordeolum)

For most styes, topical antibiotic ointment (bacitracin or erythromycin) applied directly to the eyelid margin 1-4 times daily is the recommended antibiotic treatment when conservative measures fail after 1-2 weeks. 1, 2

Initial Conservative Management (First 1-2 Weeks)

Most styes resolve spontaneously without antibiotics, so begin with conservative measures: 1, 2

• Warm compresses applied for 5-10 minutes, 3-6 times daily to soften material and promote spontaneous drainage 1, 2
• Eyelid hygiene with diluted baby shampoo or commercial eyelid cleanser once or twice daily to remove debris 2
• Gentle vertical massage of the eyelid to help express secretions from meibomian glands 2

Most styes resolve within 1-2 weeks with these measures alone. 1

When to Add Topical Antibiotics

If the stye persists beyond 1-2 weeks or worsens despite conservative treatment, add topical antibiotic ointment: 1, 2

Topical Antibiotic Selection and Application

• Bacitracin or erythromycin ointment are the first-line topical antibiotics 1, 2
• Mupirocin 2% ointment is an alternative option 2
• Apply approximately 1 cm ribbon directly to the eyelid margin where lashes emerge, NOT into the conjunctival sac 1
• Frequency: 1-4 times daily (or at bedtime), adjusted based on severity 1, 2
• Duration: Continue for a few weeks, with frequency and duration guided by clinical response 1, 2

Critical pitfall: Never apply ointment into the conjunctival sac when treating styes—the target is the lid margin where bacterial colonization occurs. 1

When to Escalate to Oral Antibiotics

For recurrent, severe, or persistent styes not responding to topical treatment, or when there are signs of spreading infection (preseptal cellulitis): 1, 2, 3

Oral Antibiotic Options

• Amoxicillin-clavulanate or cephalexin for 5-10 days to cover both Staphylococcus aureus and Streptococcus species 2, 3
• Dicloxacillin is an alternative penicillinase-resistant option 1
• Doxycycline, minocycline, or tetracycline may be considered for meibomian gland dysfunction component 2

Special Populations

• Pregnant women and children under 8 years: Use erythromycin or azithromycin instead of tetracyclines to avoid tooth staining 1, 2, 3

When to Consider Incision and Drainage

If the stye is worsening despite appropriate antibiotic therapy, incision and drainage is the next step, with reevaluation in 24-48 hours to verify clinical response. 2

Critical Pitfalls to Avoid

• Do not use corticosteroid drops for an active stye, as steroids can worsen bacterial infections 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, as this may increase intraocular pressure 1, 2
• Rotate different antibiotics if long-term or repeated treatment is needed to prevent development of resistant organisms 1, 2

When to Refer to Ophthalmology

• No improvement after incision and drainage plus appropriate antibiotic therapy 2
• Signs of orbital cellulitis or systemic illness 2
• Difficulty treating location (e.g., inner eyelid) 2

Evidence Quality Note

A Cochrane review found no randomized controlled trials evaluating non-surgical interventions for acute internal hordeolum, so current recommendations are based on expert consensus and observational data. 4, 5