Bacterial Conjunctivitis Treatment & Management

The mainstay of treatment of bacterial conjunctivitis is topical antibiotic therapy. Systemic antibiotics are indicated for Neisseria gonorrhoeae and chlamydial infections. Surgical intervention is required only when indicated for the treatment of causative conditions, such as hordeolum, nasolacrimal duct obstruction, or sinusitis.

Inpatient care for bacterial conjunctivitis would be provided only if hospitalization is indicated for other reasons. It is important to realize that, in the inpatient setting, the differential diagnosis must be carefully considered since the patients tend to be ill. Therefore, it is more common to see a red eye due to endogenous endophthalmitis or an infected corneal ulcer in this population.

Serious consideration should be given to admitting patients with hyperacute bacterial conjunctivitis if the entire cornea cannot be visualized, as there may be an early corneal ulceration, especially in Neisseria infections.^[3] Topical antibiotic, proper hygiene, and isolation are considerations for these patients.

Be aware of drug alerts, such as the one in early 2006 related to a contaminated commercial contact lens solution.

Also of special concern is trachoma, a devastating disease. See Trachoma.

Instruct patients to return for follow-up if they do not recover completely in a timely manner, so that therapy can be reassessed. Consider culture and conjunctival scrapings for resistant cases.

Please see the following for more information:

See the following for more information:

• Acute Hemorrhagic Conjunctivitis
• Allergic Conjunctivitis
• Atopic Keratoconjunctivitis
• Emergent Treatment of Acute Conjunctivitis
• Epidemic Keratoconjunctivitis
• Giant Papillary Conjunctivitis
• Keratoconjunctivitis Sicca
• Neonatal Conjunctivitis
• Superior Limbic Keratoconjunctivitis
• Viral Conjunctivitis

Practice patterns for prescribing topical antibiotics vary. Most practitioners prescribe a broad-spectrum agent on an empirical basis without culture for a routine, mild-to-moderate case of bacterial conjunctivitis. Always be aware of the differential diagnosis, and instruct patients to seek follow-up care if the expected improvement does not occur or if vision becomes affected.

Commonly used first-line topical agents include the following:

• Trimethoprim with polymixin B
• Gentamicin
• Tobramycin
• Neomycin
• Ciprofloxacin
• Ofloxacin
• Gatifloxacin
• Erythromycin

Topical antibiotics can be administered in the form of eye drops or ointments. Eye drops have the advantage of not interfering with vision. Ointments have the advantage of prolonged contact with the ocular surface and an accompanying soothing effect.

Chlamydial infection of the newborn requires systemic treatment of the neonate, the mother, and at-risk contacts. The neonate may be treated with erythromycin orally in liquid form 50 mg/kg/d in 4 divided doses for 2 weeks. The mother and at-risk contacts may be treated with doxycycline 100 mg orally twice daily for 7 days.

N gonorrhoeae infection of the newborn also requires systemic treatment of the neonate, the mother, and at-risk contacts. The neonate may be treated with intravenous aqueous penicillin G 100 units/kg/d in 4 divided doses for 1 week. The mother and at-risk contacts may be treated with a single dose of intramuscular ceftriaxone 125 mg followed by oral doxycycline 100 mg twice daily for 7 days.

Prophylaxis against ophthalmia neonatorum

Prophylaxis against ophthalmia neonatorum is a major force in the worldwide effort to prevent blindness.^[5] Common regimens are the instillation of 1% silver nitrate solution, 1% tetracycline ointment, or 0.5% erythromycin ointment.

Hygiene and avoidance of close contact accomplish deterrence of bacterial conjunctivitis with infected individuals. Patients and household members should be educated to pay attention to hygiene and the avoidance of close contact with the infected individual. It is customary to advise the infected individual to avoid sharing towels and linens.

A patient with bacterial conjunctivitis should wash hands often and avoid contaminating public swimming pools. Workers and students often are excused during the first several days of treatment to decrease the possibility of spread.

Consultations with an infectious disease specialist and/or a pediatrician may be indicated in suspected or proven chlamydial or N gonorrhoeae infections.

An experienced ophthalmic pathologist can be an excellent resource in determining the cause of a resistant conjunctivitis by interpreting conjunctival scrapings.