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Limitations of Current Antibiotics for the Treatment of Bacterial Conjunctivitis

Karpecki, Paul; Paterno, Michael R.; Comstock, Timothy L.

doi: 10.1097/OPX.0b013e3181f6fbb3

Bacterial conjunctivitis is a common ocular infection that is generally treated empirically with a broad-spectrum antibiotic. The more common pathogens causing bacterial conjunctivitis include Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus epidermidis, and Moraxella species. Several antibiotics traditionally used to treat bacterial conjunctivitis are no longer widely prescribed because of increased bacterial resistance and/or safety concerns. The introduction of the fluoroquinolone class of anti-infectives offered effective and better tolerated treatment options. Nonetheless, successful therapy for bacterial conjunctivitis continues to be limited by several factors. A primary concern is the development of bacterial resistance that may be impacted not only by widespread antibiotic use but also by antibacterial pharmacokinetics, such as maintenance of insufficient bactericidal concentrations at the site of infection. In addition, poor adherence to prescribed regimens that require frequent administration, along with undesirable adverse events, affects the development of bacterial resistance and the success of treatment regimens. This article reviews current antibacterial agents used to treat bacterial conjunctivitis, factors that limit their successful use in treatment, and options for future development of more effective topical ophthalmic anti-infective agents.




Koffler Vision Group, Lexington, Kentucky (PK), and Bausch & Lomb, Inc., Rochester, New York (MRP, TLC).

Dr. Paul M. Karpecki: AMO, paid consultant; Allergan Inc, paid consultant; Bausch & Lomb Inc, paid consultant; CZM, speakers bureau; Cyanacon Ocusoft, paid consultant; Eyemaginations, paid consultant; Focus Laboratories, paid consultant; Hoya Surgical, paid consultant; Inspire Pharmaceuticals, paid consultant, shareholder, research grant; Ista Pharmaceuticals, paid consultant; Konan Medical, paid consultant; LCA Vision, LASIK Plus, Advisor; Pixel Optics, paid consultant; Odyssey Medical, paid consultant; OfficeMate/VSP, paid consultant; QLT, research grant; Rapid Pathogen Screening, paid consultant; Science Based Health, paid consultant; Sirion Therapeutics, paid consultant; TearLab Inc., paid consultant, shareholder; Topcon, paid consultant; VMax, paid consultant/shareholder. Drs. Michael Paterno and Timothy Comstock are employees of Bausch & Lomb, Inc.

Received April 22, 2010; accepted July 12, 2010.

Paul Karpecki; Koffler Vision Group; 120 N Eagle Creek Drive, Suite 431; Lexington, Kentucky 40509; e-mail:

© 2010 American Academy of Optometry