With some exceptions, antibiotic treatment of bacterial conjunctivitis is NOT required because the course is usually self-limited. However, because topical antibiotics may shorten the clinical course, the choice of whether to use antibiotics for the treatment of acute bacterial conjunctivitis is driven by patient preferences (for example in back to work or school situations).
•Antibiotics for some patients
For patients who select antibiotic treatment for bacterial conjunctivitis, we suggest treatment with either erythromycin ophthalmic ointment (0.5 inch applied to the lower lid) or trimethoprim-polymyxin B drops (one to two drops) over alternative agents (Grade 2C). Either agent is administered four times daily for five to seven days. Ointment is preferred over drops for children, those with poor compliance, and those in whom it is difficult to administer eye medications. Patients who do not respond to antibiotic treatment within a few days should also be referred to an ophthalmologist.
Patients requiring ophthalmologic referral
–Contact lens wearers
For all contact lens wearers with bacterial conjunctivitis, we suggest antibiotic treatment (Grade 2C). Fluoroquinolones are the preferred agent to treat bacterial conjunctivitis in contact lens wearers due to the high incidence of Pseudomonas infection. Patients should stop wearing contact lens. If there is any corneal opacity or suspicion of keratitis, the patient should be evaluated by an ophthalmologist.
–Hyperacute bacterial conjunctivitis
Hyperacute bacterial conjunctivitis due to Neisseria typically require systemic therapy. This is discussed separately.
–Chlamydial infection
Patients with chlamydial infection (typically a chronic infection) require systemic antibiotic therapy. This is discussed separately.
Treatment of viral, allergic, or noninfectious conjunctivitis
•Viral
Topical antihistamine/decongestants and/or lubricating agents may provide symptom relief for patients with viral conjunctivitis.
•Allergic
The management of allergic conjunctivitis is discussed separately.
•Noninfectious
For patients with noninfectious conjunctivitis, topical lubricants may provide symptom relief and can be used as often as six times daily.
●No role for corticosteroids
Ophthalmic corticosteroids have no role in the management of acute conjunctivitis and should not be prescribed by primary care clinicians for this indication.
