Which topical antibiotics should be used to treat bacterial conjunctivitis (pink eye)?

Updated: Jan 03, 2019
  • Author: Karen K Yeung, OD, FAAO; Chief Editor: Andrew A Dahl, MD, FACS  more...
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For mild and non–vision-threatening bacterial conjunctivitis, older-generation antibiotics should be used. Later-generation antibiotics and the latest fluoroquinolones should be reserved for more serious infections to minimize the risk of developing microbial resistance. [23] The following are older topical antibiotics that remain efficacious:

  • Trimethoprim with polymyxin B
  • Azithromycin
  • Gentamicin
  • Tobramycin
  • Neomycin
  • Ciprofloxacin
  • Ofloxacin
  • Gatifloxacin
  • Erythromycin
  • Bacitracin

For moderate and severe bacterial conjunctivitis, the latest fluoroquinolones, including moxifloxacin, besifloxacin, and levofloxacin, are generally effective. Rare severe infections may also require patient hospitalization to ensure consistent administration of fortified aminoglycoside-cephalosporin combination therapy, fortified topical vancomycin, or topical fluoroquinolone monotherapy treatment every 15 minutes to hourly. All are effective treatments, although fortified antibiotics must be prepared without preservatives in compounding pharmacies and must remain refrigerated because of their shorter shelf life.

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