Complete the Full Treatment Course for Bacterial Conjunctivitis
You should restart tobramycin eye drops and complete a full 5-7 day course, as stopping treatment prematurely at 5 days when mild discharge persists indicates incomplete bacterial eradication and risks treatment failure. 1, 2
Why You Need to Complete Treatment
The American Academy of Ophthalmology recommends a 5-7 day course of topical antibiotics for bacterial conjunctivitis, not just "until symptoms improve." 1, 2 Stopping at 5 days when discharge is still present means:
- Incomplete bacterial eradication - The infection is not fully cleared 2
- Risk of recurrence - Partially treated infections commonly return 1
- Potential antibiotic resistance - Subtherapeutic treatment duration promotes resistant organisms 1
Specific Treatment Plan
Restart tobramycin immediately and continue for the full prescribed duration:
- Dosing: 1-2 drops in the affected eye(s) every 4 hours while awake 3
- Duration: Complete at least 7 days total from when you first started (so 2 more days minimum) 1, 2
- Do not stop until discharge completely resolves AND you've completed the full course 2
Signs You're Improving (What to Look For)
You should see progressive improvement including: 4
- Reduced discharge amount and thickness
- Less eye redness
- Decreased eyelid swelling
- Less crusting in the morning
- Reduced discomfort
When to Seek Immediate Medical Attention
Stop and see a doctor urgently if you develop: 1
- Vision changes or blurring - suggests corneal involvement requiring immediate ophthalmology referral
- Moderate to severe eye pain - not just mild irritation
- Worsening symptoms after 48-72 hours of restarting treatment
- Severe purulent (thick yellow-green) discharge - may indicate gonococcal infection requiring systemic antibiotics 4, 1
Why Tobramycin May Not Be Optimal
While tobramycin is effective, fourth-generation fluoroquinolones like moxifloxacin 0.5% provide superior gram-positive coverage including some MRSA strains and are now preferred first-line agents. 1 If symptoms don't improve within 3-4 days of restarting tobramycin, you may need to switch to moxifloxacin or another fluoroquinolone. 1, 2
Critical Pitfall to Avoid
Never taper below therapeutic dosing (don't reduce to 2-3 times daily) as subtherapeutic levels increase antibiotic resistance risk. 4 Either use the full prescribed frequency or stop completely once the full course is done. 4
Alternative if Tobramycin is Unavailable
If you cannot obtain more tobramycin, mild bacterial conjunctivitis may resolve with supportive care alone (cold compresses, preservative-free artificial tears), as 64% of cases resolve naturally by days 6-10. 1 However, completing antibiotic treatment provides faster resolution and reduces transmission risk. 2