Bacterial Conjunctivitis in Adults - Guideline for the management of
|Last review: 26/07/2018|
|Next review: 26/07/2021|
|Approved By: Improving Antimicrobial Prescribing Group|
|Copyright© Leeds Teaching Hospitals NHS Trust 2018|
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
Guideline for the management of bacterial conjunctivitis in adults
Conjunctivitis presents as an acute, red, gritty, sticky eye(s), usually bilateral but may be sequential; purulent discharge with crusty lids and diffusely injected conjunctiva. The rapidity of progression and severity of symptoms determines classification, treatment and investigation - see background.
With a unilateral red eye it is important to exclude serious causes e.g. glaucoma, keratitis and iritis. These should be suspected if any of the following features occur.
Any patient with conjunctivitis who is suspected to have Stevens-Johnson syndrome must be referred immediately to an ophthalmic specialist.
The characteristic features of conjunctivitis are:-
Recommendation: Patients with contact lenses should remove their lenses until all symptoms of infection have resolved and for at least 24 hours after the treatment has been completed.
Recommendation: Lubricant eye drops or gel can reduce discomfort. (Oxyal, Liquifilm or Celluvisc 1% or Carbomer 0.2% eye gel three to four times a day are suitable lubricants).
Recommendation: Secretions from the lid and lashes should be removed with cotton wool soaked in water.
|Empirical Antimicrobial Treatment|
Recommendation: topical antimicrobials should not be routinely used for non-severe acute conjunctivitis.
Recommendation: patients not prescribed topical antimicrobials should be advised to return or be reviewed in 3 days if symptoms are worse or no better.
Recommendation: For acute conjunctivitis requiring treatment first line therapy is chloramphenicol 0.5% eye drops (initially one drop is instilled into the affected eye(s) every 2 hours for 2 days, and then every 4 hours for 5 days) OR 1% eye ointment (applied four times a day for 2 days then twice a day for 5 days.)
Recommendation: For patients who are allergic/intolerant to chloramphenicol, are pregnant, have a history, or family history of blood dyscrasias, fusidic acid is an alternative. A 7 day course is recommended.
Recommendations: For hyperacute conjunctivitis first line treatment is Ceftriaxone 2g 24-hourly IV. A single dose without corneal involvement or for 3 days if cornea is involved.
In conclusion if conjunctivitis is mild it is worth not treating with antibiotics prescribing lubricants and counselling patients on hygienic measures to prevent spread with a proviso to return if symptoms do not improve in 3 days. For moderate to severe symptoms treatment should be prescribed.
|Directed Antimicrobial Treatment (when microbiology results are known)|
When the results of microbiology samples are known it may be necessary to… amend therapy. Discuss with Microbiology as necessary.
|Duration of Treatment|
Acute conjunctivitis: 1 week.
If conjunctivitis persists for more than two weeks the patient must be re-evaluated. Swabs for bacteria and Chlamydia must be taken. Treatment will depend on results of the swabs. If Chlamydia is present the patient must be referred to a sexually transmitted disease clinic for systemic treatment and contact testing.
|Clinical condition:||Bacterial Conjunctivitis|
|Target patient group:||Any adult patient with conjunctivitis|
|Target professional group(s):||Secondary Care Doctors
- Sheikh A, Hurwitz B, van Schayck CP,McLean S, Nurmatov U. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD001211. DOI: .1002/14651858.CD001211.pub3. Accessed 15th July 2015
- Everitt Hazel A, Little Paul S, Smith Peter W F. A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice BMJ 2006; 333 :321
- Clinical knowledge summary. Conjunctivitis infective. Revised December 2007.
A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. LTHT consensus.
Improving Antimicrobial Prescribing Group
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