Treatment of Bacterial Conjunctivitis

First-Line Treatment

The American Academy of Ophthalmology recommends a 5- to 7-day course of broad-spectrum topical antibiotic applied 4 times daily for bacterial conjunctivitis in a 14-year-old 1
Topical antibacterial therapy is associated with earlier clinical and microbiological remission, reduced transmissibility, and earlier return to school 1

Consider obtaining conjunctival cultures before starting treatment if severe or if gonococcal infection is suspected 2
For severe cases, consider referral to an ophthalmologist, especially if there is visual loss 3, moderate or severe pain 3, severe purulent discharge 3, corneal involvement 4, or lack of response to therapy 5

If gonococcal infection is suspected, systemic antibiotic therapy is necessary in addition to topical treatment 4
For a 14-year-old with gonococcal conjunctivitis weighing ≥45 kg, the Centers for Disease Control and Prevention recommends Ceftriaxone 125 mg IM, single dose 6
For a 14-year-old with chlamydial conjunctivitis ≥8 years, the Centers for Disease Control and Prevention recommends Azithromycin 1 g orally, single dose or Doxycycline 100 mg orally, twice daily for 7 days 6
Sexual abuse should be considered in children with gonococcal or chlamydial infections 5

Patients should be advised to return for evaluation in 3-4 days if they note no improvement 4
For gonococcal conjunctivitis, daily follow-up is recommended until resolution 5

Hand washing is important to reduce the risk of transmission 3
Avoid sharing towels, pillows, and close contact with others during the period of contagion 7
Patients can generally return to school once treatment has been initiated for 24 hours and symptoms begin to improve 3

Increasing bacterial resistance is a concern, particularly with methicillin-resistant S. aureus (MRSA) 1
If no improvement is seen after 3-4 days of treatment, consider alternative diagnoses or resistant organisms 4
Contact lens wearers with conjunctivitis should be referred to an ophthalmologist due to higher risk of complications 5