For years, the drugs of choice for simple conjunctivitis have been sulfacetamide, mycins, aminoglycosides, or related combinations (i.e., Polysporin, Neosporin, Polytrim). Because of increased bacterial resistance, recent published articles have advised against use of these medications in favor of the more expensive fluoroquinolones. Did any other intervening factors play a role in this decision?—DANNYLU WILSON, CNS, DSN, Columbia, Tenn.
Bacterial conjunctivitis is common. In the United States, the most likely causative organism depends on whether the patient is a neonate (Chlamydia trachomatis, Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, or Neisseria gonorrheae), child (H. influenzae, S. pneumoniae, or S. aureus), or adult (S. aureus, coagulase-negative Staphylococcus organisms, H. influenzae, S. pneumoniae, Moraxella species, or Acinetobacter species). In sexually active patients, N. gonorrheae is a frequent cause of hyperacute bacterial conjunctivitis, and C. trachomatis may be the cause of a chronic bacterial conjunctivitis in which there is red eye with purulent discharge persisting for longer than a few weeks; treatment of conjunctivitis from these organisms requires systemic antibiotics. Empiric management with topical antibiotics can be used to treat bacterial conjunctivitis from most other organisms (Cleveland Clinic J Med. 2008;75:507-512). Even amoung outpatients, the ocular pathogens have demonstrated an increase in resistance to antibiotics resulting in a decreased susceptibility of the most common bacterial isolates to ophthalmic antimicrobial agents—even the older fluoroquinolone ciprofloxacin. A recent study on the impact of antibiotic resistance in the management of ocular infections concludes that the newer fluoroquinolones (gatifloxacin, moxifloxacin, and soon besifloxacin) may be the best choices for treating ophthalmic infections (Clinical Ophthalmology. 2009;3:507-521).—Philip R. Cohen, MD (138-4)