Bacterial conjunctivitis Etiology

The vast majority of conjunctivitis cases are viral in nature. For acute bacterial conjunctivitis, the cause is primarily gram-positive organisms.11 The primary pathogens in acute bacterial conjunctivitis are Streptococcus pneumoniae, Staphylococcus aureus, or Haemophilus influenzae.12

Staphylococcus, Moraxella, or other opportunistic bacteria typically cause chronic conjunctivitis.10 Moraxella infections may cluster in groups of women who share 12

makeup. Both acute and chronic bacterial conjunctivitis are self-limiting except

if caused by staphylococci. Because of this, the pathogens are rarely cultured unless the case is unresponsive to treatment. While infection typically begins in one eye, it will often spread to both within 48 hours.11

Hyperacute bacterial conjunctivitis is associated with gonococcal infections in sexually active patients. The causative agents are Neisseria gonorrhoeae or N. men-ingitidis. Prompt workup and treatment is required, as corneal perforation occurs in 10% of cases within 48 hours.12 An ophthalmologist should complete a conjunctival scraping and susceptibility testing.10

S/mplom Pain or Photophobia?

Possible uveitis, acula narrow anglo glaucoma, keralitis, or oiners- Refer lo ophlfialnnjlogist lor diagnosis

Conjunctivitis Pathophysiology Diagram
FIGURE 63-1. Differential diagnosis for red eye.


General Approach to Treatment

• Complete resolution of the bacterial conjunctivitis

• Prevent adverse consequences of the infection

• Preserve functionality of the eye

General Approach to Treatment

Treat acute bacterial conjunctivitis with broad-spectrum antibiotics. Although the condition is usually self-limiting, antibiotic treatment decreases the spread of disease to other people and prevents extraocular infection. Additionally, treatment may help decrease the risk of corneal ulceration or other complications that affect sight. Finally, treatment speeds recovery.14

S/mplom Pain or Photophobia?

Possible uveitis, acula narrow anglo glaucoma, keralitis, or oiners- Refer lo ophlfialnnjlogist lor diagnosis

Pharmacologic Therapy

The choice of an antibiotic agent for acute bacterial conjunctivitis is largely empiric.

The initial treatment needs to include Staphylococcus coverage, but also may be chosen on the basis of cost and side-effect profile.13,14 In general, ointments are a good dosage form for children. Adults may prefer drops because they do not interfere 14

with vision.

Many broad-spectrum topical antibiotics are approved to treat acute bacterial conjunctivitis (Tables 63-2 and 63-3). Polymyxin B/trimethoprim solution, polymyxin B with bacitracin ointment, or erythromycin ointment are cost-effective, first-line treatments. The aminoglycosides (tobramycin, neomycin, and gentamicin) are alternatives but have incomplete gram-positive coverage.14 The aminogly-cosides can cause corneal epithelial toxicity. Neomycin often causes allergic reactions. Tobramycin is the best tolerated of the class, but is also the most expensive. Sulfacetamide 10%

shows increasing resistance. If infection recurs, use a topical fluoroquinolone like

ofloxacin, ciprofloxacin, norfloxacin, gatifloxacin, moxifloxacin, or levofloxacin. Fluoroquinolones are not used first-line for conjunctivitis because they have poor Streptococcus coverage and are expensive. Development of resistance is also a concern with fluoroquinolones.14

Treat hyperacute bacterial conjunctivitis with a single dose of 1 g of intramuscular ceftriaxone in combination with topical antibiotics.11

Patients with chronic bacterial conjunctivitis often have a concurrent case of blepharitis. Add a lid hygiene regimen to topical antibiotic treatment.12

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