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.

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


  1. All physicians are not well eqipped, they depend on the REPS with NEW drug,expensive


    I had eyesurgery and in the post-op pack was MAXIDEX(dexamethasone) drops by ALCON LABS.

    Two days later I was BLIND

    Use Google and enter EPOCRATES MAXIDEX REACTION to verify

    Or call 800-757-9195

  3. What?! No chloramphenicol??

  4. Why chloramphenicol? It's bacteriostatic (not bactericidic) and at least the oral use can induce aplastic anemia. This should be enough.

  5. Chloramphenicol? Not worth the risk- although small, small risk. 4th generation fluoroquinols are the ticket. I would like to know more on the Maxidex and blindness- it contains a steroid ( secondary viral infections are possible) and neomycin (which about 20% of the planet is allergic to in ophhalmic dosage.

  6. The statistic that 20% of people are allergic to neomycin sounds exaggerated. Can you provide a link to a PubMed article please?