Bacterial conjunctivitis treatment guidelines

Bacterial conjunctivitis normally lasts 1-2 weeks and heals on its own. Topical antibiotic therapy is the mainstay of care for bacterial conjunctivitis, with the aim of dramatically decreasing the duration of symptoms and the risk of contagion. The antibiotic should, ideally, be specific for the organism that is causing the problem. Unfortunately, while bacterial culturing is recommended, it is not always possible or cost-effective in routine cases, and Gram stain results can take several days.

Older-generation antibiotics can be used for moderate and non-vision-threatening bacterial conjunctivitis. To avoid the development of bacterial resistance, later-generation antibiotics should be reserved for more severe infections.

Factors that predispose

Infectious conjunctivitis is more common in children and the elderly.

(NB: Bacterial conjunctivitis in the first month of life is a serious condition that requires immediate referral to an ophthalmologist; see the Clinical Management Guideline on Ophthalmia Neonatorum for more information.)

  • contamination of the conjunctival surface
  • superficial trauma
  • contact lens wear (NB infection may be Gram –ve)
  • secondary to viral conjunctivitis
  • recent cold, upper respiratory tract infection [NB refer also to Clinical Management Guideline on Conjunctivitis (viral, nonherpetic)] or sinusitis
  • diabetes (or other disease compromising the immune system)
  • steroids (systemic or topical, compromising ocular resistance to infection)
  • blepharitis (or other chronic ocular inflammation)


Acute manifestations of:

  • redness
  • discomfort, usually described as burning or grittiness
  • discharge (may cause temporary blurring of vision)
  • crusting of lids (often stuck together after sleep and may have to be bathed open)

Normally bilateral – one eye will be affected first, then the other (by one or two days)

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  • Crusting on the lid
  • Discharge that is purulent or mucopurulent
  • Fornices have the most conjunctival hyperaemia.
  • Mild papillary reaction in the tarsal conjunctiva is possible.
  • Cornea: normally unaffected (occasionally punctate epitheliopathy affecting the lower third of the cornea). Consider the risk of gonococcal infection if the cornea is substantially affected.
  • Pre-auricular lymphadenopathy is almost never present.

Differential diagnosis

Other forms of conjunctivitis

  • epidemic keratoconjunctivitis (e.g. adenovirus)
  • Herpes simplex or Herpes zoster
  • Chlamydial infection
  • allergy

Other causes of acute red eye

  • angle closure glaucoma
  • infective keratitis
  • anterior uveitis


When it comes to conjunctivitis, it’s often necessary to seek medical help (pink eye). This isn’t always important, though. Cold compresses and artificial tears, which can be purchased over the counter without a prescription, can help alleviate some of the discomfort and dryness induced by conjunctivitis. You can also refrain from wearing contact lenses before the eye doctor confirms it’s safe to do so. If you didn’t need to see a doctor, don’t put your contacts in until you’re no longer experiencing pink eye symptoms.

When Do You Seek Medical Help?

If you have conjunctivitis and any of the following symptoms, you should see a doctor:


  • As discharge is washed from the eye, it causes discomfort, sensitivity to light, or blurred vision that does not improve (s)
  • a weakened immune system, such as from HIV infection, cancer treatment, or other medical conditions or treatments, including pink eye thought to be caused by bacteria that does not improve after 24 hours of antibiotic use a weakened immune system, such as from HIV infection, cancer treatment, or other medical conditions or treatments, including pink eye thought to be caused by bacteria that does not improve after 24 hours of antibiotic use

Conjunctivitis signs in newborns should be seen by a doctor right away.

Bacterial Conjunctivitis is a conjunctivitis caused by bacteria.

For bacterial conjunctivitis, your doctor can prescribe an antibiotic, which is typically given topically as eye drops or ointment. Antibiotics can aid in the reduction of infection duration, complications, and the spread of infection to others [1]. In the following situations, antibiotics may be required:

    • With discharge (pus)
    • When conjunctivitis occurs in people whose immune system is compromised

  • When certain bacteria are suspected

Mild bacterial conjunctivitis can improve without the use of antibiotics and without causing complications. It usually recovers in 2 to 5 days without medication, but it can take up to 2 weeks to fully disappear.

Discuss the right care options for your infection with your doctor.

Bacterial conjunctivitis treatment guidelines

Bacterial conjunctivitis treatment guidelines

Mayo Clinic

Bacterial conjunctivitis treatment guidelines