Antibiotic eye drops for bacterial conjunctivitis: which one to choose?

According to the current clinical evidence, 64% of cases of acute bacterial conjunctivitis improve spontaneously and do not require local antibiotic therapy with eye drops.

When antibiotic therapy is indicated for bacterial conjunctivitis, the most cost-effective options are the eye drops listed below that are included in the Walmart $4 prescription medication program:

• Sulfacet Sodium 10% op. solution
• Tobramycin 0.3% op. solution

Tobramycin is better tolerated because it causes less local irritation, often described as stinging and burning. This improves the compliance especially in younger children.

Sulfacetamide 10% has a better gram-positive than gram-negative coverage.

Antibiotic-containing eye medications available in the $4 Prescription Program by Walmart:

• Bacitracin op. ointment
• Erythromycin op. ointment
• Gentamicin 0.3% op. solution
• Neomycin/Polymyxin/Dexamethasone 0.1% op. ointment
• Neomycin/Polymyxin/Dexamethasone 0.1% op. suspension
• Polymyxin Sulfate/TMP op. solution
• Sulfacet Sodium 10% op. solution
• Tobramycin 0.3% op. solution

Gentamicin is used for gram-negative bacterial coverage but tends to be toxic to epithelia and retards healing. Aminoglycoside antibiotics include Gentamicin, Neomycin and Tobramycin.

Ciprofloxacin 3% is a broad-spectrum antibiotic with good gram-positive and gram-negative coverage (not included in the $4 program).

Gatifloxacin ophthalmic solution 0.3% (Zymar) is fourth-generation fluoroquinolone ophthalmic indicated for bacterial conjunctivitis.

References:
Conjunctivitis. AFP, 1998.
$4 Prescription Program. Walmart, PDF.
Should We Prescribe Antibiotics for Acute Conjunctivitis? AFP, 2002.
Image source: Conjunctivitis, Wikipedia, public domain.