Guidelines
Guidelines Summary
The following are guidelines on bacterial conjunctivitis treatment by the American Academy of Ophthalmology [34] :
Mild conjunctivitis
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Empiric choice of antibiotic is common for bacterial conjunctivitis
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A 5- to 7-day course of a broad-spectrum topical antibiotic typically is effective
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Selection of antibiotic can be based on convenience or cost, as no specific antibiotic is superior
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Povidone-iodine 1.25% ophthalmic solution may be as effective as topical antibiotics, especially in resource-limited settings
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There is no data supporting the cost-effectiveness of antibiotics for mild bacterial conjunctivitis; however, their use can shorten morbidity and should be considered on an individual basis.
Moderate to severe bacterial conjunctivitis
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Moderate to severe bacterial conjunctivitis is characterized by purulent discharge, pain, and marked eye inflammation
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Conjunctival cultures and Gram staining should be done if gonococcal infection is suspected
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Choice of antibiotic for severe cases is guided by laboratory test results
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Methicillin-resistant S aureus (MRSA) increasingly is isolated in bacterial conjunctivitis cases
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MRSA is resistant to many commercially available topical antibiotics
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Infants in neonatal intensive care (NICU) with low birth weight or gestational age are more likely to have gram-negative resistant conjunctivitis that is resistant to gentamicin
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Microbiology testing may guide therapy, which could include compounded topical antibiotics like vancomycin
Gonococcal conjunctivitis
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Systemic antibiotic therapy is needed to treat gonococcal conjunctivitis
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Saline lavage can promote comfort and faster resolution of inflammation
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Topical treatment for bacterial keratitis should be added if there is corneal involvement
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Patients and their sexual contacts should be informed about the possibility of concomitant diseases and referred as appropriate
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Sexual abuse should be considered in pediatric patients with gonococcal or Chlamydia infections
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Daily follow-up is recommended for patients with gonococcal conjunctivitis until resolution
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At each follow-up visit, obtain interval history and perform visual acuity measurement and slit-lamp biomicroscopy
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Patients with other types of bacterial conjunctivitis should return for a follow-up visit in 3 to 4 days if there is no improvement
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Neisseria meningitis should be ruled out as the causative organism before attributing the infection to N gonorrhoeae
Chlamydial conjunctivitis
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Systemic therapy is indicated for infants with chlamydial conjunctivitis due to potential infections at other sites
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Empiric antibiotic therapy can be considered for patients with symptoms strongly suggestive of chlamydia, such as follicular conjunctivitis persisting for several weeks
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There is no evidence to support the use of topical therapy in addition to systemic treatment
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Patients should be reevaluated following treatment due to a high incidence of treatment failure
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Follow-up visit should include interval history, visual acuity measurement, and slit-lamp biomicroscopy
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Adult conjunctivitis typically responds to systemic therapy, and sexual contacts should be treated simultaneously
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Patients and sexual contacts should be told about the possibility of concomitant diseases and referred as appropriate
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Sexual abuse should be considered in children with chlamydial conjunctivitis
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In low- to middle-income countries with limited antibiotic access, povidone-iodine 1.25% ophthalmic solution can be used to treat chlamydial conjunctivitis
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