From the Guidelines
For bacterial conjunctivitis treatment, a 5- to 7-day course of a broad-spectrum topical antibiotic is usually effective, and the most convenient or least expensive option can be selected. When considering treatment options, it's essential to weigh the benefits of topical antibacterial therapy, which has been shown to lead to earlier clinical and microbiological remission compared to placebo, particularly in the first 2 to 5 days of treatment 1. Some key points to consider when treating bacterial conjunctivitis include:
- The choice of antibiotic is usually empiric, and there is no clinical evidence suggesting the superiority of any particular antibiotic 1.
- Povidone-iodine 1.25% ophthalmic solution may be as effective as topical antibiotic therapy for treating bacterial conjunctivitis and could be considered when access to antibiotics is limited 1.
- Treatment may reduce transmissibility and allow for an earlier return to school for children, which is an important consideration in terms of quality of life and reducing the spread of infection.
- It's crucial to practice good hygiene, including frequent handwashing, avoiding touching or rubbing eyes, using separate towels and washcloths, and discarding eye makeup to prevent the spread of infection.
- Contact lens wearers should temporarily switch to glasses until the infection resolves to prevent further irritation and potential complications. Given the current evidence, the primary goal of treatment should be to reduce morbidity and prevent the spread of infection, while also considering the potential benefits and drawbacks of different treatment options 1.
From the FDA Drug Label
The recommended dosage regimen for the treatment of bacterial conjunctivitis is: Instill 1 drop in the affected eye(s) twice daily, eight to twelve hours apart for the first two days and then instill 1 drop in the affected eye(s) once daily for the next five days. The treatment dosing and timing for bacterial conjunctivitis with azithromycin (OPHTH) is:
- Twice daily for the first two days, with 8-12 hours between doses
- Once daily for the next five days It is important to complete the full course of therapy to ensure effectiveness and prevent bacterial resistance 2.
From the Research
Bacterial Conjunctivitis Treatment
Overview of Treatment Options
- Bacterial conjunctivitis can be treated with topical antibiotics, which have been shown to decrease the duration of the infection and allow for an earlier return to school or work 3.
- The development of resistance to antibiotics is a concern, and fluoroquinolones should be reserved for severe infections due to their broad spectrum of activity 4.
- Antibiotics such as gentamycin, tobramycin, and azithromycin are preferred for the treatment of bacterial conjunctivitis 4.
Dosing and Timing of Treatment
- Gatifloxacin 0.5% ophthalmic solution administered twice daily for 5 days has been shown to be effective in the treatment of acute bacterial conjunctivitis in patients one year of age or older 5.
- Moxifloxacin ophthalmic solution 0.5% (VIGAMOX) has also been shown to be effective in the treatment of bacterial conjunctivitis, with a potency that is comparable to other fluoroquinolones 6.
- The total effective rate of gatifloxacin treatment has been reported to be 95% in a double-blind randomized controlled clinical trial 7.
Considerations for Treatment
- The high spontaneous healing rate of acute conjunctivitis should be considered when deciding on treatment, and delayed topical antibiotics or treatment without antibiotics using artificial tears and eye bathings may be considered in some cases 4.
- Additive anti-inflammatory drugs are generally not recommended for the treatment of bacterial conjunctivitis 4.
- Chronic-recurrent follicular conjunctivitis necessitates testing for Chlamydia, and in case of a positive result, systemic antibiotic treatment of the patient and sexual partner is recommended 4.