From the Guidelines
Mild bacterial conjunctivitis is usually self-limited and can be treated with a 5- to 7-day course of a broad-spectrum topical antibiotic, which may reduce transmissibility and allow for an earlier return to school for children. The choice of antibiotic is usually empiric, and there is no clinical evidence suggesting the superiority of any particular antibiotic 1.
Key Considerations
- The use of topical antibacterial therapy is associated with earlier clinical and microbiological remission compared with placebo in days 2 to 5 of treatment 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 morbidity, and the choice of therapy is an individual decision, considering the shortened morbidity associated with antibiotic use 1.
Treatment Approach
- A broad-spectrum topical antibiotic can be selected based on convenience or cost, as there is no evidence suggesting the superiority of any particular antibiotic 1.
- The standard treatment regimen typically involves applying the antibiotic drops 4 times daily or ointment 2-3 times daily for 5-7 days.
- Patients should practice good hygiene, such as avoiding touching or rubbing their eyes, using separate towels and washcloths, washing hands frequently, and disposing of eye makeup.
- Contact lens wearers should stop wearing lenses until the infection resolves completely.
From the FDA Drug Label
Moxifloxacin ophthalmic solution, 0. 5% is indicated for the treatment of bacterial conjunctivitis caused by susceptible strains of the following organisms: AzaSite ® is indicated for the treatment of bacterial conjunctivitis caused by susceptible isolates of the following microorganisms:
The treatment for bacterial conjunctivitis is moxifloxacin ophthalmic solution or azithromycin ophthalmic solution.
- The dosage for moxifloxacin ophthalmic solution is:
- Instill one drop in the affected eye 3 times a day for 7 days 2
- The dosage for azithromycin ophthalmic solution 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 3
From the Research
Treatment Options for Bacterial Conjunctivitis
- Topical antibiotics such as polymyxin B sulfate/trimethoprim and moxifloxacin are effective in treating bacterial conjunctivitis 4
- Moxifloxacin has been shown to be more effective and faster in reducing symptoms and disease transmission compared to polymyxin B sulfate/trimethoprim 4
- Fluoroquinolones, such as moxifloxacin and besifloxacin, have good activity against common ocular bacterial pathogens and can be used to treat bacterial conjunctivitis 5, 6
Antibiotic Therapy
- Antibiotic therapy is widely used for the treatment of acute bacterial conjunctivitis 7
- Topical antibiotics have been shown to be beneficial in improving clinical and microbiological remission rates compared to placebo 7
- The use of antibiotic eye drops can speed the resolution of symptoms and infection 7
Specific Antibiotics
- Besifloxacin is a topical ophthalmic fluoroquinolone that has been approved for the treatment of bacterial conjunctivitis caused by susceptible bacterial strains 6
- Moxifloxacin is a topical fluoroquinolone that has been shown to be effective in treating bacterial conjunctivitis and has a higher potency and faster in vitro "speed-to-kill" compared to non-fluoroquinolones 8
- Topical moxifloxacin has been shown to be cost-effective and can generate total healthcare budget savings by reducing the costs of managing treatment failures and the use of clinicians' time to manage such failures 8
Treatment Strategies
- Treatment strategies for bacterial conjunctivitis vary significantly between countries, with most patients being first seen in primary care and receiving "wait-and-see", lubrication, and antiseptic or antibacterial treatment 8
- The use of novel topical fluoroquinolones, such as moxifloxacin, should be considered earlier in the treatment path for conjunctivitis 8