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Treatment of bacterial conjunctivitis and keratitis
Last reviewed: 06.07.2025
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In acute conjunctivitis, presumably caused by dangerous pathogens ( gonococcus, pseudomonas aeruginosa ), treatment begins immediately, without waiting for laboratory confirmation of the diagnosis, since a delay of 1-2 days can lead to the development of a corneal ulcer up to its perforation. The eye of a child with conjunctivitis is not covered with a bandage to prevent the occurrence of conditions favorable for the proliferation of bacteria.
For acute staphylococcal conjunctivitis, local antibacterial drugs are prescribed: picloxidine, fusidic acid, tobramycin, chloramphenicol 0.25% (if ineffective - 0.3% drops), ofloxacin, ciprofloxacin or lomefloxacin 3-4 times a day, eye ointment (tetracycline, erythromycin or ofloxacin) 2-3 times a day.
In case of gonococcal conjunctivitis (proven or suspected), in the first days of the disease, wash the eyes with a solution of benzylpenicillin (10,000 U/ml) 4 times per hour, apply 1% tetracycline or 0.5% erythromycin ointment every hour, then gradually reduce the number of procedures to 4 times per day. In severe cases - instillation of 0.3% solution of ofloxacin, ciprofloxacin or lomefloxacin into the eyes up to 6 times per day. Intramuscular administration of benzylpenicillin is possible; in case of penicillin intolerance, cephalosporins are prescribed.
In case of conjunctivitis caused by Pseudomonas aeruginosa, the drugs of choice are aminoglycoside antibiotics: tobramycin 0.3%, gentamicin 0.3%, the therapeutic effect is increased by their combination with quinolone antibiotics locally (ofloxacin, ciprofloxacin, lomefloxacin) in drops and ointments in the first 2 days 6-8 times a day, then up to 3-4 times a day. If the infection spreads to the cornea - tobramycin, gentamicin parabulbar injections.
Additional treatment of bacterial conjunctivitis: in case of swelling and severe irritation of the conjunctiva, add instillations of antiallergic or anti-inflammatory drops (cromoglycic acid, olopatadine, ketotifen or diclofenac) 2 times a day. In case of corneal damage - corneal regeneration stimulants (taurine, dexpanthenol, vitapos).