## Acute Bacterial Conjunctivitis: Management Principles ### Key Point: **Systemic antibiotics are NOT routinely indicated for uncomplicated acute bacterial conjunctivitis.** Topical therapy alone is sufficient for most cases caused by common pathogens like *Staphylococcus aureus*, *Streptococcus pneumoniae*, and *Haemophilus influenzae*. ### When Systemic Antibiotics ARE Required: | Organism | Indication | Systemic Therapy | |----------|-----------|------------------| | *Neisseria gonorrhoeae* | Purulent discharge, risk of corneal involvement | Ceftriaxone IM + azithromycin | | *Chlamydia trachomatis* | Neonatal inclusion conjunctivitis | Erythromycin or azithromycin | | Gram-negative (severe) | Immunocompromised, orbital cellulitis risk | Fluoroquinolone or aminoglycoside | ### High-Yield: **Topical fluoroquinolones** (moxifloxacin, gatifloxacin, ofloxacin) are the first-line agents for uncomplicated acute bacterial conjunctivitis because they provide broad-spectrum coverage and achieve high ocular surface concentrations. ### Clinical Pearl: *Neisseria gonorrhoeae* causes hyperacute conjunctivitis (onset within 24–48 hours post-exposure) with profuse purulent discharge and risk of rapid corneal perforation — this ALWAYS requires systemic therapy (ceftriaxone 1 g IM single dose) plus topical antibiotics and frequent irrigation. ### Mnemonic: HAC (Hyperacute Acute Chronic) - **H**yperaucute (< 24 hrs): *N. gonorrhoeae* — systemic + topical - **A**cute (2–7 days): Bacterial (*S. aureus*, *H. influenzae*, *S. pneumoniae*) — topical only - **C**hronic (> 2 weeks): Viral, chlamydial, allergic — organism-specific ### Most Common Causative Organisms: - **Community-acquired:** *Staphylococcus aureus* (most common), *Streptococcus pneumoniae*, *Haemophilus influenzae* - **Neonatal:** *Neisseria gonorrhoeae*, *Chlamydia trachomatis* - **Hospital-acquired:** *Pseudomonas aeruginosa*, *Serratia marcescens*
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