Augmentin Should Not Be Used for Pink Eye
Augmentin (amoxicillin-clavulanic acid) is not recommended for treating pink eye (conjunctivitis), as bacterial conjunctivitis requires topical antibiotics, not oral therapy, and the specific pathogens requiring systemic antibiotics (gonorrhea and chlamydia) need different agents entirely. 1, 2
Why Oral Antibiotics Like Augmentin Are Inappropriate
Topical antibiotics are the standard of care for routine bacterial conjunctivitis, achieving high tissue concentrations directly at the infection site, while oral antibiotics like Augmentin cannot reach therapeutic levels in the conjunctiva 1, 2
Mild bacterial conjunctivitis is self-limited, resolving spontaneously in 64% of cases by days 6-10 without any treatment, making systemic antibiotic exposure unnecessary and promoting resistance 2
Oral antibiotics are reserved exclusively for two specific pathogens: gonococcal conjunctivitis (requiring ceftriaxone) and chlamydial conjunctivitis (requiring azithromycin or doxycycline), neither of which is treated with Augmentin 1, 2, 3
What Should Be Used Instead
For Bacterial Conjunctivitis
First-line treatment: Topical fluoroquinolones such as moxifloxacin 0.5% three times daily for 5-7 days, which provide superior gram-positive coverage including some MRSA strains 2, 3
Alternative topical options: Gentamicin, tetracycline, or ofloxacin 0.3% four times daily for 5-7 days if fluoroquinolones are unavailable 1, 3
Expected response: Reduced discharge, pain, and lid edema within 24-48 hours; if no improvement by 48 hours, obtain cultures and consider switching agents 3
For Viral Conjunctivitis
Supportive care only: Refrigerated preservative-free artificial tears four times daily and cold compresses for symptomatic relief 2
No antibiotics needed: Topical antibiotics should be avoided as they provide no benefit and risk adverse effects and resistance 1, 2
For Allergic Conjunctivitis
- First-line treatment: Second-generation topical antihistamines with mast cell-stabilizing properties 2
Critical Red Flags Requiring Different Management
Gonococcal conjunctivitis: Requires systemic ceftriaxone 250 mg IM single dose plus azithromycin 1 g orally, with daily monitoring until resolution 2, 3
Chlamydial conjunctivitis: Requires oral azithromycin 1 g single dose OR doxycycline 100 mg twice daily for 7 days, as more than 50% of patients have concurrent infection at other sites 2, 4, 3
Immediate ophthalmology referral needed for: Visual loss, moderate-severe pain, severe purulent discharge, corneal involvement, conjunctival scarring, lack of response to therapy, history of HSV eye disease, or immunocompromised state 2
Common Pitfalls to Avoid
Do not use oral antibiotics when topical drops are unavailable—instead use supportive care alone, as unnecessary systemic antibiotic exposure promotes resistance and causes adverse effects (GI upset, drug interactions, C. difficile risk) that outweigh any theoretical benefit 2
Do not assume all purulent discharge is routine bacterial conjunctivitis—obtain conjunctival cultures and Gram staining if gonococcal infection is suspected, as delayed referral leads to poor outcomes including corneal perforation and vision loss 1, 2
Do not use topical corticosteroids without ruling out HSV—they are absolutely contraindicated in HSV epithelial infections as they potentiate viral replication and worsen the infection 2