February 2, 2024

Bacterial conjunctivitis is a common eye problem. Most cases are not severe, and they get better on their own. But because it’s so common, it can impact society by causing people to miss school or work. Doctors often use antibiotics to make the symptoms disappear faster and stop the infection’s spread.

Specific bacteria cause some rare and more severe forms of bacterial conjunctivitis. These can lead to severe eye problems.

What is Bacterial Conjunctivitis?

Bacterial conjunctivitis is an infection of the eye’s mucous membrane, the conjunctiva. This membrane covers the inner surface of the eyelids (palpebral and tarsal conjunctiva), reaches into the fornices, and extends onto the eye’s surface (bulbar conjunctiva) until it connects with the cornea at the limbus.


  • Red eye: Unilateral, bilateral, or sequentially bilateral
  • Discharge: Typically purulent, but can be thin or thick, mucopurulent, or watery
  • Irritation, burning, stinging, discomfort
  • Tearing
  • Light sensitivity
  • Intolerance to contact lens
  • Fluctuating or decreased vision


  • Bulbar conjunctival injection
  • Palpebral conjunctival papillary reaction
  • Muco-purulent or watery discharge
  • Chemosis
  • Lid erythema
  • Conjunctival membranes

Diagnostic Procedures:

Diagnostic procedures such as Gram stain or cultures are generally not required for routine cases. However, in certain situations, these procedures may be recommended:

Rapid Antigen Test for Adenovirus:

A quick in-office test for adenovirus can aid in confirming the viral cause of conjunctivitis.

Gram Stain & Cultures:

Used in atypical cases, such as hyperacute or chronic/non-responding conjunctivitis.
Cultures are performed on Chocolate and blood agar.

Viral Culture or PCR:

Useful to differentiate between viral and bacterial conjunctivitis when the clinical diagnosis is unclear.

Bacterial Conjunctivitis Management

The majority of cases of acute bacterial conjunctivitis resolve on their own within 8-10 days without any eye treatment. However, some more aggressive organisms may lead to persistent symptoms and chronic colonization. Antibiotic treatment has demonstrated effectiveness in reducing symptom duration and hastening the elimination of microorganisms from the conjunctival surface.

General Treatment

Bacterial conjunctivitis is contagious, necessitating patient education on proper hygiene and handwashing. The exact duration of contagion is unpredictable, and recommendations for time away from work vary. A recent survey of ophthalmologists suggests 1 to 3 days away from work or until the infection clears.

Supportive Therapy

Supportive measures for conjunctivitis include applying cool compresses and using preservative-free artificial tears, administered two to six times daily.

Antibiotics Treatment for Bacterial Conjunctivitis

Antibiotics have led to a faster clinical and microbiological improvement than a placebo, particularly in the initial 2-5 days of treatment. This can contribute to reducing disease transmission and lowering overall incidences within the population.

Common Antibiotics for Acute Bacterial Conjunctivitis


  • 2nd generation: Ciprofloxacin 0.3% drops or ointment, or Ofloxacin 0.3% drops
  • 3rd generation: Levofloxacin 0.5% drops
  • 4th generation: Moxifloxacin 0.5% drops, Gatifloxacin 0.5% drops, or Besifloxacin 0.6% drops


  • Tobramycin 0.3% drops
  • Gentamicin 0.3% drops


  • Erythromycin 0.5% ointment
  • Azithromycin 1% solution


  • Bacitracin ointment
  • Bacitracin/Polymixin B ointment
  • Neomycin/Polymixin B/Bacitracin
  • Neomycin/Polymixin B/gramicidin
  • Polymixin B/Trimethoprim
  • Sulfacetamide
  • Chloramphenicol (Note: Not available for topical use in the US due to potential side effects)
  • Fusidic Acid
  • Povidone-iodine 1.25% may be effective if the above antibiotics are unavailable.

For Neisseria Gonorrhoeae and Chlamydia Trachomatis:

Systemic antibiotics are necessary:

  • Macrolides: Azithromycin (1gm single dose) or Erythromycin
  • Doxycycline or Tetracycline (Avoid in pregnant and nursing mothers)
  • Erythromycin for children less than or equal to 45 kg

Neisseria Gonorrhoeae:

  • Ceftriaxone 250mg Intramuscular injection once + Azithromycin 1 gram PO once.
  • Doxycycline 100mg PO BID for seven days
  • For cephalosporin allergy, Azithromycin 2g PO once
  • For Children < 18 years old: Ceftriaxone 125mg IM once OR Spectinomycin 40mg/kg IM once (max dose 2grams)

When to Consider Antibiotics for Pink Eye?

Antibiotic eye drops or ointments may be necessary for the bacterial pink eye under the following circumstances:
1- Severe Symptoms:
Antibiotics may be recommended if the symptoms of pink eye are particularly severe.
2- Weakened Immune System:
Individuals with a compromised immune system, which can occur with conditions like HIV/AIDS, might require antibiotics.
3- No Improvement in a Week:
Antibiotic intervention may be considered if the infection shows no improvement within a week without treatment.

The Bottom Line

Antibiotics play a crucial role in managing bacterial conjunctivitis. While many cases of acute bacterial conjunctivitis may resolve on their own, antibiotic treatment is essential for several reasons. Antibiotics can expedite both clinical and microbiological remission, especially in the initial days of therapy, reducing the duration of symptoms and aiding in eradicating microorganisms. This not only accelerates the recovery of affected individuals but also diminishes the transmission of the disease, lowering its prevalence within the population.

Always consult an eye doctor to seek advice and the appropriate antibiotic for bacterial conjunctivitis. The eye doctor will evaluate the severity of symptoms, consider any underlying conditions, and prescribe the most effective antibiotic tailored to your specific needs. Prompt and accurate medical guidance ensures the optimal management of bacterial conjunctivitis, enhancing the chances of a swift recovery and preventing the spread of the infection.

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