Empiric Therapy Regimens
Bacterial conjunctivitis is a microbial infection involving the mucous membrane of the surface of the eye. It is less common than viral conjunctivitis. The source of bacterial conjunctivitis can be endogenous or exogenous. It can have a slow, acute, or hyperacute onset. Depending on the pathogen, bacterial conjunctivitis may be a benign self-limited illness (most cases), may be sight-threatening, or may signify a severe underlying systemic disease. In patients with chronic unilateral bacterial conjunctivitis, the ipsilateral nasolacrimal system should be examined to rule out canaliculitis, nasolacrimal duct obstruction, or dacryocystitis. [1]
General and empiric therapeutic recommendations for acute bacterial conjunctivitis are provided below. [2] This review does not cover the treatment of hyperacute conjunctivitis, neonatal conjunctivitis, or trachoma.
General recommendations in the treatment of bacterial conjunctivitis
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.
Most practitioners prescribe a broad-spectrum agent on an empiric basis without culture for a routine mild to moderate case of bacterial conjunctivitis. [2]
Treatment recommendations for acute non-severe bacterial conjunctivitis
Regimens for acute nonsevere bacterial conjunctivitis are as follows:
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Erythromycin ophthalmic ointment: Apply 1-cm ribbon QID for 5-7 days or
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Polymyxin B-trimethoprim ophthalmic solution: Instill 1 drop QID for 5-7 days or
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Sulfacetamide ophthalmic solution: Instill 1 drop QID for 5-7 days or
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Azithromycin ophthalmic solution: Instill 1 drop BID for 2 days, then 1 drop for 5 days or
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Tobramycin ophthalmic solution: Instill 1 drop q4h for 5-7 days or
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Ciprofloxacin ophthalmic solution: Instill 1 drop every 2 hours while awake for 2 days, then 1 drop every 4 hours while awake for the next 5 days or
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Levofloxacin ophthalmic solution: Instill 1 drop in affected eye(s) every 2 hours while awake (up to 8 times daily) on days 1-2; instill 1 drop in affected eye(s) every 4 hours while awake (up to 4 times daily) on days 3-7 or
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Moxifloxcacin ophthalmic solution: Instill 1 drop QID for 5-7 days or
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Ofloxacin ophthalmic solution: Instill 1 drop in affected eye(s) every 2-4 hours on days 1-2; instill 1 drop QID on days 3-7 [1, 2]
In conjunctivitis otitis syndrome, Haemophilus conjunctivitis in children, or conjunctivitis associated with a pharyngitis, a supplemental oral antibiotic should be considered.
