If you know the sensitivity profile of the organism, it is best to use drugs from the list of those that it is sensitive to. I would prefer using fluoroquinolones like cipro, or modi or an amino glycoside like tobra or amikacin if it is available.some of these agents can cause punctuate epithelial keratopathy, so watch out for that since secondary corneal insult can keep the eye red with watering.

Use the aminoglycosides like gentamicin or polymmyxin B which are effective against infection due to P.aeruginosa.

Thank you for your answers. Knowing the sensitivity profile of the organism can surely help to choose the best antibiotic. But often we have to choose the therapy without knowing it yet!

Why did you suspect the conjunctivitis to be due to Pseudomonas? Do you swab each case of conjunctivitis?

Sergio, in unknown sensitivity cases, you may try using fluoroquinolones or amino glycosides. But you need to determine it is Ps.aeruginosa to start with. Sometimes you may need to use fortified eye drops, these have more potential to cause SPKs

I usually swab the patients with conjunctivitis refractory to treatment after adequate time of topical therapy.

Dear Sergio,

1. Be careful to the quality of the swab. It may be contaminated.

2. Look for P. aeruginosa in the antiseptic solutions used to treat children for various eye infections. looking for the source is best, because there are no "healthy" carriers.

3. If you know the agent is P. aeruginosa, the susceptibility testing comes with the identification.

4. ask to implement a cummulative report (anual) to assess the susceptibility of the stains isolated from various sources, and the you will be able to treat with the initial empiric antibiotic successfully.

5. Ciprofloxacin and aminoglycosides like tobra are good.

6. I use the microbiologic loop to sample the conjunctiva and inoculate the solid media on the spot, to try to reduce contamination. Make a smear Gram stained from the eye discharge, it is very useful.

In my opinion, start with 3rd -Levofloxacine or 4th Moxifloxacin or Gatifloxacin generation of fluoroquinolones , but it very important to avoid resistance prescribing 4 or more times a day. Additionally could be used Betadine 2.5% . I think it is enough for conjunctivitis, but a good combination is Tobramycin added to quinolones.

Good luck

Thank you Marianne!

Dear Sergio,

I appreciate your kindness.

Wishing you continued successful work.

Regards,

Marianne