Antibiotics - Eye Infections

Bacterial Conjunctivitis

Infection	Bacterial conjunctivitis
Most likely organisms	Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus.
Empiric treatment	Topical Chloramphenicol 0.5% eye drops four times a day x 5-7 days. If adult inclusion conjunctivitis suspected (Chlamydia trachomatis), seek specialist advice.
In penicillin allergy	As above.
Duration	As above.
Comments	Always take a swab. Alternatives: Fusidic acid eye drops: apply twice daily

Adult Inclusion Conjunctivitis

Infection	Adult inclusion conjunctivitis
Most likely organisms	Chlamydia trachomatis
Empiric treatment	Azithromycin 1g po stat. Alternative: Doxycycline 200mg stat then 100mg q12h po for 14 days.
In penicillin allergy	As above.
Duration	If Doxycycline - use for 14 days.
Comments	Corneal involvement may occur. must refer patient for STD screen.

Pre-septal Cellulitis

Not involving the orbit

Infection	Preseptal cellulitis (not involving the orbit)
Most likely organisms	Streptococcus pneumoniae, Staphylococcus aureus, Group A streptococcus, Haemophilus influenzae.
Empiric treatment	If pre-septal cellulitis Mild not involving orbit and systemically well use: Co-amoxiclav 625mg q8h po. If Moderate severe or involving orbit or febrile, treat as orbital cellulitis with: Piperacillin-tazobactam 4.5g q8h iv plus Clindamycin 600mg q6h po. Piperacillin/tazobactam should not be used if Hx of penicillin allergy. Consult microbiology. Oral switch after improvement in signs: Co-amoxiclav 625mg q8h PO.(Seek advice if MRSA) Urgent referral to ophthalmology.
In penicillin allergy	If pre-septal cellulitis Mild, not involving orbit and systemically well use: Clarithromycin 500mg q12h po. If Moderate severe or involving orbit or febrile: Contact micro for advice. Piperacillin/tazobactam should not be used if history of penicillin anaphylaxis. Consult microbiology.
Duration	Duration total 10-14 days.
Comments	If MRSA suspected add either (Vancomycin loading dose then 15mg/kg q12h iv or Teicoplanin 6mg/kg q12h iv for 3 doses, then q24h thereafter). * Clarithromycin can cause significant increases in INR. For patients on Warfarin and Clarithromycin, INR must be monitored very closely and appropriate Warfarin dose adjustments made as necessary.

Orbital Cellulitis

Infection	Orbital & pre-septal cellulitis
Most likely organisms	Streptococcus pneumoniae, Staphylococcus aureus, Group A streptococcus, Haemophilus influenzae
Empiric treatment	Piperacillin-tazobactam 4.5g q8h iv plus Clindamycin 600mg q6h po. Oral switch after improvement in signs: Co-amoxiclav 625mg q8h po (seek advice if MRSA)
In penicillin allergy	Piperacillin/tazobactam should not be used if history of penicillin anaphylaxis. Consult microbiology.
Duration	10-14 days.
Comments	Urgent referral to ophthalmology. CT scan necessary. If MRSA suspected add either (Vancomycin loading dose then 15mg/kg q12h iv or Teicoplanin 6mg/kg q12h iv for 3 doses, then q24h thereafter).

Herpes Zoster Ophthalmicus

Infection	Herpes zoster ophthalmicus
Most likely organisms	HZV
Empiric treatment	Valaciclovir 1g q8h po.
In penicillin allergy	As above.
Duration	10 days.
Comments	Consider referral to ophthalmology. If sight is threatened, use IV acyclovir 10mg/kg q8h iv. Use IBW to calculate dose and check Creat. Clearance. Check ↓dose in renal impairment.

Suspected endophthalmitis

Infection	Suspected endophthalmitis
Comments	Urgent referral to ophthalmology.

Corneal Infection

Keratitis

Infection	Keratitis (corneal infection)
Comments	Urgent referral to ophthalmology.

Appendices

Appendix 1 Switching from IV to PO therapy
Appendix 2 Aminoglycoside monitoring
Appendix 3 Vancomycin
Appendix 4 Clostridium difficile diarrhoea
Appendix 5 MRSA
Appendix 6 Renal impairment, antibiotics
Appendix 7 IV preparations
Appendix 8 Prescribing Tips
Prophylaxis - Endocarditis
Prophylaxis - Meningitis
Prophylaxis - Post Splenectomy /Hyposplenic
Penicillin Allergy
SEPSIS.

Links

Content By Dr. Íomhar O' Sullivan 10/08/2010. Last review Dr. ÍOS 7/04/16.