Antibacterial medications are not indicated in most viral conjunctivitis unless significant corneal epithelial damage then they are used to prevent secondary bacterial infections. For symptomatic improvement, consider artificial tears, ocular decongestant/antihistamine (i.e., naphazoline/pheniramine), topical nonsteroidals, and cool compresses.
If bacterial conjunctivitis is suspected, Gram stain, culture appropriately and start on a broad spectrum topical agent (e.g., polymyxin/ trimethoprim, ciprofloxacin, ofloxacin, levofloxacin 4-8x/day or gatifloxacin, moxifloxacin 3-6x/day). Certain etiologies (i.e., Neisseria gonorrhea) are relative emergencies and should be managed according to specific regimens.
Most commonly caused by Chlamydia trachomatis, Strep, viridans, Staph, aureus, Haemophilus influenzae, group B Streptococcus,Moraxella catarrhalis, or Neisseria gonorrhea. Treatment is guided by Gram stain (which should be performed immediately to identify N.gonorrhea) and culture results. N. gonorrhea and C. trachomatis have specific regimens as described. If not gonococcal or chlamydial, may use erythromycin or bacitracin ointment Q4-6 hr. as the only initial treatment. In the United States, neonatal conjunctivits is most commonly chlamydial.
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