Bacterial conjunctivitis
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Bacterial conjunctivitis

Conjunctivitis refers to any inflammatory condition of the conjunctiva. It is most commonly caused by viruses, allergies, or bacteria. This overview will briefly review clues to the etiology of bacterial conjunctivitis and its treatment.

Denver lasik Signs and symptoms

  • Abrupt onset
  • Burning, irritation, mild itching, tenderness to palpation
  • Copious yellow-green mucopurulent or purulent discharge (often associated with morning crusting)
  • Initially unilateral infection, with the second eye involved a few days later
  • Marked conjunctival injection, chemosis, lid swelling, and tender preauricular adenopathy
Treatment of bacterial conjunctivitis
Mild bacterial conjunctivitis may be self-limited and resolve spontaneously. The duration, recurrence rate, and morbidity associated with the most common types of bacterial conjunctivitis may decrease with topical antibacterial therapy.1

Choosing an anti-infective
Since cultures are generally not performed for mild conjunctivitis, a broad-spectrum anti-infective is recommended and usually successful. In choosing the appropriate anti-infective, there are several factors to consider. The ideal topical anti-infective should offer broad-spectrum coverage, effectiveness against resistant pathogens, low MIC90 values, and excellent tolerability. Common topical anti-infectives include sulfonamides, aminoglycosides, polymyxin-based combinations, and fluoroquinolones.

The growing problem of resistance
Many would argue that the issue of antibacterial resistance should also be a primary consideration when choosing an ophthalmic anti-infective. The increase in the resistance rates of third-generation fluoroquinolones, particularly Gram-positive organisms, is well documented. Indeed, the resistance rate of third-generation fluoroquinolones to Staphylococcus species has grown 39%,2 and the resistance rate for S aureus is at an all-time high of 35%.3 Consequently, these anti-infectives no longer provide the thorough coverage optometrists require of a treatment regimen.

The advent of an ideal ophthalmic anti-infective
Representing the most advanced group of compounds in their class, fourth-generation fluoroquinolones were developed to combat the growing problem of resistance. While third-generation fluoroquinolones require only a single mutation to develop resistance, fourth-generation fluoroquinolones require a dual mutation, the likelihood of which is quite rare. Not only do fourth-generation fluoroquinolones discourage resistance, but they also demonstrate enhanced activity against otherwise-resistant species.4,5 Increased in vitro bactericidal activity against Gram-positive pathogens, as well as equivalent, and in some cases enhanced, in vitro activity against Gram-negative pathogens compared with third-generation fluoroquinolones has also been demonstrated.6

Conclusion
There is evidence that the eyecare community recognizes the importance of minimizing resistance and maintaining flouroquinolone efficacy, as many have responsibly switched to fourth-generation fluoroquinolones.7 Given their distinct advantages, fourth-generation fluoroquinolones promise to become the treatment of choice for bacterial conjunctivitis.

The preceding discussion may be helpful in identifying and treating bacterial conjunctivitis. However, it is recommended that clinicians refer to the published literature for more definitive diagnostic criteria and evidence for treatments.


1. American Academy of Ophthalmology. Conjunctivitis, Preferred Practice Pattern. San Francisco, Calif: American Academy of Ophthalmology; 2003.
2. Edelson E. New antibiotic seen as more effective in fighting bacteria. Ophthalmol Times. 2002;27(7):46.
3. Goldstein MH, Kowalski RP, Gordon YJ. Emerging fluoroquinolone resistance in bacterial keratitis: a 5-year review. Ophthalmology. 1999;106(7):1313-1318.
4. Blondeau JM. Fluoroquinolones: mechanism of action, classification, and the development of resistance. Surv Ophthalmol. 2004;49(Suppl 2):S73-S78.
5. Mah FS. Fourth-generation fluoroquinolones: new topical agents in the war on ocular bacterial infections. Curr Opin Ophthalmol. 2004;15(4):316-320.
6. Data on file, Allergan,Inc., 2002; Pivotal Clinical Study SPCL-GFLX 3/02.
7. SourceTMPrescription Audit (SPA), Verispan L.L.C., December 2005-January 2006.


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