Management
24
Bacterial Conjunctivitis
Î Mild bacterial conjunctivitis is usually self-limited and typically
resolves spontaneously without specific treatment in immune-
competent adults. (I+, G, S)
Î Use of topical antibacterial therapy is associated with earlier clinical
and microbiological remission compared with placebo in days 2–5 of
treatment. (I+, G, S)
Î Because a 5-to-7-day course of a broad-spectrum topical antibiotic is
usually effective, the most convenient or least expensive option can be
selected. (III, I, D)
Î Conjunctival cultures and slides for Gram staining should be obtained
if gonococcal infection is a possibility. (III, I, D)
Î The choice of antibiotic is guided by the results of laboratory tests if
gonococcal infection is a possibility. (III, I, D)
Î Systemic antibiotic therapy is necessary to treat conjunctivitis due to
Neisseria gonorrhoeae and Chlamydia trachomatis. (III, I, D)
Î Topical therapy, while not necessary, is usually used. (III, I, D)
Î Saline lavage may promote comfort and more rapid resolution of
inflammation in gonococcal conjunctivitis. (III, I, D)
Î If corneal involvement is present, the patient should also be treated
topically as for bacterial keratitis. (II++, G, S)
Î Patients and sexual contacts should be informed about the possibility
of concomitant disease and referred appropriately. (III, G, S)
Î Sexual abuse should be considered in children with this condition.
(III, I, D)
Î Patients with gonococcal conjunctivitis should be seen daily until
resolution of the conjunctivitis. (III, I, D)
Î At each follow-up visit, an interval history, visual acuity measurement,
and slit-lamp biomicroscopy should be performed. (III, I, D)
Î For other types of bacterial conjunctivitis, patients should be asked to
return for a visit in 3–4 days if they note no improvement. (III, I, D)
