What is the recommended first-line antibiotic treatment for bacterial conjunctivitis in adults and children?

Recommended first-line antibiotic treatment for bacterial conjunctivitis in both adults and children:

• Topical antibiotics are generally not routinely prescribed as most cases are self-limiting and resolve within 5–7 days without treatment.
• If treatment is required due to severity or need for rapid symptom resolution, chloramphenicol 0.5% eye drops are recommended as first-line: apply 1 drop every 2 hours for 2 days, then reduce frequency to 3-4 times daily depending on severity, continuing until 48 hours after infection clears.
• Alternatively, chloramphenicol 1% ointment can be used, applied 3-4 times daily until 48 hours after infection clears.
• Fusidic acid 1% eye drops is considered a second-line option, applied 1 drop twice daily until 48 hours after infection clears.
• There is no clinical evidence to suggest superiority of any particular antibiotic, but Public Health England recommends chloramphenicol as second-line and fusidic acid as third-line due to spectrum of activity.

These recommendations apply from age 1 month onwards and are consistent for both adults and children.

For contact lens wearers, antibiotics effective against Gram-negative organisms (e.g., aminoglycosides like gentamicin or quinolones) are preferred, but this is a special circumstance.

Patient education and delayed prescribing strategies (starting antibiotics if symptoms persist beyond 3 days) are also advised.

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