Treatment of bacterial conjunctivitis
Bacterial conjunctivitis can be primary or secondary (eg nasolacrimal duct obstruction) and is more common in children. For differentiation of types of conjunctivitis, see Assessment of conjunctivitis.
Common causes of bacterial conjunctivitis include Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae (especially in children younger than 5 years who are not fully vaccinated, often causing ‘conjunctivitis–otitis syndrome’).
Conjunctivitis caused by Chlamydia trachomatis or Neisseria gonorrhoeae requires specific assessment and antibiotic treatment; see Chlamydial conjunctivitis and Gonococcal conjunctivitis.
Conjunctivitis caused by Neisseria meningitidis is considered a systemic disease and requires prompt referral; treatment is as for invasive meningococcal disease – see Neisseria meningitidis (meningococcal meningitis).
Systematic reviews have found that topical antibiotics provide modest improvement in clinical cure and speed of recovery from bacterial conjunctivitisChen, 2023. However, most cases resolve within 7 days without treatment.
Prescribe topical antibiotic therapy for neonates and young infants with bacterial conjunctivitis, and consider therapy in patients who present with marked symptoms (eg purulent discharge).
Advise patients to carefully clean excessive mucus with a tissue or cotton bud before using topical antibiotic therapy. Use:
1chloramphenicol 0.5% eye drops, 1 drop into the affected eye, 4 times daily until symptoms improve or for up to 7 days1 chloramphenicol chloramphenicol chloramphenicol
OR
2framycetin 0.5% eye drops, 1 drop into the affected eye, 4 times a day until symptoms improve or for up to 7 days. framycetin framycetin framycetin
Chloramphenicol and framycetin can cause contact hypersensitivity reactions, which may be severe. Aminoglycoside (eg gentamicin, tobramycin) and quinolone (eg ciprofloxacin, ofloxacin) eye drops are not recommended for empirical treatment.
If conjunctivitis persists despite topical antibiotic therapy, perform bacterial and viral conjunctival swabs to identify atypical or resistant organisms, or consider referral to an ophthalmologist to exclude alternative diagnoses.
Prompt referral to an ophthalmologist is required for conjunctivitis that is associated with severe or worsening symptoms (eg significant pain, reduced vision or photophobia) to exclude more serious diagnoses such as keratitis.