The most common gram-positive bacteria that are causative agents of conjunctivitis include Staphylococcus aureus, Streptococcus pneumoniae, and group A and B streptococci (Fig. 41-3). Gram-negative organisms include Haemophilus influenzae, Escherichia coli, and Pseudomonas aeruginosa. Bacterial conjunctivitis can occur at any age from the first day of life. Chemosis (edema of bulbar conjunctiva), purulent discharge, lid edema, and injection are common signs. Associated systemic septicemia can occur, especially with Pseudomonas infection. Cultures should be prepared on blood and chocolate agar.
A topical fluoroquinolone often provides effective treatment for severe cases before culture results (Leibowitz, 1991). Gram-negative organisms are best treated with tobra-mycin or a topical fluoroquinolone. Systemic antibiotics are recommended when there is evidence of systemic disease. Physicians should use caution with gentamicin, neomycin, and sulfacetamide eye medications, because these drugs may cause a toxic chemical conjunctivitis and complicate management. Patients with mild conjunctivitis generally respond to erythromycin or bacitracin ointment.
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