Should We Prescribe Vigamox Eye Drops for Pink Eye?

May 6, 2009

I see many patients who are referred to me by pediatricians and ER docs, and it seems they all are taking some fourth generation fluoroquinolone like Vigamox eye drops for bacterial conjunctivitis (or pink eye). What’s up with that? Is it just plain laziness to prescribe the same thing over and over? Or is it the result of drug rep pressure? I reserve these superdrugs to contact lens wearers. Otherwise, my patients with conjunctivitis get sulfa or gentamicin or some other cheap, old medicine. I wish doctors would take a moment before reflexively prescribing Vigamox and other very powerful drugs for what is a benign, self-limited disease.




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156 Responses to “Should We Prescribe Vigamox Eye Drops for Pink Eye?”

  • ari weitzner

    once started, always important to finish the full course.

  • Kacy B

    My 3 year old son has conjunctivitis. We started the Vigamox last Friday evening and since then the yellow-sticky discharge has cleared but there is much more inflammation and discomfort with increased blepharodema, photophobia and blepharospasm. Today he developed fever and also has symptoms of rhinitis and sore throat. His doc put him on systemic antibiotics so with the oral a/b is it still so important to administer the Vigamox for the full course.

  • Dr. Ari Weitzner

    conjunctivitis is a self-limited disease. it always goes away, treated or not. which is why vigamox is just plain overkill. viral conj can last for weeks or even months sometimes, and is not treatable, but typically the discharge is whitish and scant.

    blepharitis can mimic conjunctivitis, and is very very common as we get older. the treatment for that is good lid hygiene, taking flaxseed/omega three supplements, and an antibiotic called azasite every night, sometimes indefinitely.

    btw, the cephalaxin will treat your pinkeye if its truly bacterial. if its viral (most sore throat is viral) it wont make a difference

  • Rache'l Clark

    I am 63 years old and have had conjunctivitis for over a month now–bacterial. I have used Polymixin B Sulfate, used it for a week and my eyes were marginally better. Four days later it was back. Went to my own doctor and he prescribed Gentamicin. Was on it for 5 days and my eyes got so bad with green matter and all the whites of BOTH eyes were filled with blood and the orbs and bone around them were terribly painful. It even hurt the eye muscles to blink my eyes. He then prescribed Vigamox as my last resort. It was $85 at Wal-Mart. (I have no insurance). Since it was so expensive, I used it for 11.5 days. And once again, my eyes were not cleared up. This all started July 13, 2010. Today is Aug. 21, 2010.
    I did a photo shoot today, in terribly hot weather, so the sweat was running down into my eyes, and tonight lots of green matter and terrible redness is back with me.
    So in my estimation, Vigamox does NOT clear conjunctivitis up!
    Is there ANYTHING that will help?????? Very Frustrated!

  • Angelina Mattera

    I went to the doctor yesterday with what I think was a strep throat. He never really verified what it was, but did prescribe me Cephalexin. Today I woke up with pink eye and I was wondering if the two could be related? If so, would if the antibiotic he prescribed help with the pink eye as well?

    Thanks for your help in advance!

  • ari weitzner

    i agree!

  • amy turner

    I am allergic to sulfa, tobramycin, azasite, keratolac, gentamycin, and neomycin. I’ve just been prescribed vigamox and told it does not contain sulfa and shouldn’t be pose a problem given my allergies to other medications. Do you agree with that?
    Thank you very much

  • ari weitzner

    sounds like typical viral conjunctivitis, but since you started the Vigamox drops, you ought to finish the course.
    if viral, and you work with kids, you ought to stay home for a week- very contagious. otherwise, if you dont touch anyone, wash your hands a lot and use a hand sanitizer and wipe off your work station, you can go back to work.

  • Sharo

    Wow, as a patient with pink eye for the first time, this is all very confusing. After a day with a very red and itchy right eye, I called the doctors office. I was concerned about whether or not I should be going to work (i.e. around other people.)

    Based on my symptoms (no contacts, no yellow discharge) the doc said it was most likely viral, but I should use the anti-bacterial drops “just in case.” She said even if it’s viral “it can’t hurt.” I even pushed back a bit, saying I don’t like to take antibiotics if they are not necessary, and she told me not to worry, that they’re “just eye drops” and that she wasn’t putting me on antibiotics. She told me to stay home from work for 24 hours.

    I went and got the $75 (!!!) drops. Before using any drops, the right eye seemed to be improving (not as itchy) but I saw signs of redness and itchyness in the left eye, so I began the Vigamox regimine.

    The doctor said that she treats eye infections “conservatively” and even threw out there that untreated infections can cause blindness (scare tactic??) Basically, a better safe than sorry approach.

    I would have been willing to wait things out, but was/am still concerned about returning to work. I cannot afford to stay home for a week! Should I still be quarantined? Can I return, but just be careful about touching, hand-washing and sanitizing? I’m assuming since I’ve already paid for and started the Vigamox that I should continue.

  • Dr. Ari Weitzner

    the pink eye just ran its course regardless of the vigamox. once started, however, once started, its a good idea to finish the course of antibiotics.

  • Uche

    I also thought that my daughter was prescribed moxifloxacin ophth. drop too soon in the course of her conjuctivitis. Her red eye appeared after swimming in a hotel pool. I first thought it was an allergy and tried visine for two days, to get the red eye (unilateral-Rt) out and stop the irritation. I began to notice that the red eye got worse and she complained of severe itchiness. I started noticing some discharge (slightly yellowish) and sticky eye. I also noticed that the Lt. eye was a bit pinkish. Now that she has used Vigamox three times a day for 2 days, the Rt. eye has gotten worse. It is swollen and more reddish than ever. She is now experincing watery eyes, and itchiness, along with “stye”. She is also having some stuffy nose. I have been applying warm water to her eyes as advised by her pediatrician. I plan to contact her pediatrician tomorrow to report these reactions. I will not be instilling further drops until I have a chance to consult with her pediatrician. I actually wondered the use of fluoroquinolone as the first line agent.

  • Dr. Ari Weitzner

    most conjunctivitis is contagious for about a week, so thats how long she should stay out of school. if the conjunctivitis is bacterial, and she did not use vigamox, i dont think it would make much of a difference re contagion, as most conjunctivitis gets better in about a week regardless of treatment. but if its a nasty case, and there is still green discharge after a week, then she is probably still contagious.

  • John V

    My daughter (5yrs old) got mild pink eye with green discharge and crust on the eyelashes. We waited 2 days before going to the walk in clinic.

    We got the Vigamox and started the treatment. Her eye is better but she also has a cough and stuffy nose.

    Dr. Weitzner when you say:
    “i am going to give you what i give my own children when they get pink eye– nothing. and just like it goes away in about a week with them on no treatment, so it will with you”.

    My daughter is in school JK half days. How long should she stay home if we didn’t use the VIgamox?

  • ari weitzner

    i suspect that the gentamicin made the eyes feel better initially simply due to lubrication, and would have produced same results as artificial tears.

    viral conj can last up to 2 weeks or even more. as long as not getting worse, i would have waited another week.

    hard to explain why the gent made it worse if the gent agreed with you in the past (gent can irritate the eyes in many patients and makes the conj look worse).
    but agree if eyes getting worse after gent, no choice but to go to the big guns like vigamax. but if there wasn’t significant discharge going on, hard to believe we are dealing with a resistant bacterial organism.

    it bears repeating that even bacterial conj is a self-limited disease and will go away no matter what (except in cases of std’s). so, again, i would advise waiting at least 2 weeks as long as its not getting worse and see no signs of significant bacterial infection like heavy discharge etc.

    as i mentioned, i never treat my own children, to my wife’s chagrin (“you’re an eye doctor!! can’t you give them something?!” “shut up, honey dear!”)

  • Ashley

    As a healthcare provider with small children with conjunctivitis, I waited about 6 days, no treatment, and with no change when I got conjunctivits, (hoping it was viral).

    Then I got a Rx for Gentamicin (gentamicin has always worked in the past). I saw improvement the first three days, then both eyes flared up worse than ever before. I stopped taking anything for a few days and was gradually getting worse.

    Got Rx for Vigamox and am slowly seeing improvement. If I didn’t see improvement, I would have had bacteria cultured. Glad there are these drugs on the market, but I agree they shouldn’t be first line of defense.

  • Dr. Ari Weitzner

    most conjunctivitis is viral and is NOT treated AT ALL, like when you catch a cold. the fact that it was so contagious in your family makes me 99% certain it was viral- bacterial not nearly as contagious. therefore, the vigamox, or any drop you took, was worthless- the course would have been the same.

    here’s what i say to my patients with conjunctivits: “i am going to give you what i give my own children when they get pink eye– nothing. and just like it goes away in about a week with them on no treatment, so it will with you”. my patients find it reassuring that an ophthalmologist doesnt even treat his own kids.

    so, leave your family alone, and it will go away sooner or later- guaranteed!

  • Amber

    Dr. Weitzner,
    I appreciate your comment and agree completely with your outlook. I did not know I had other options when my little girl was treated with Vigamox for bacterial conjunctivitis. She took two doses each day for five days, it went away (or so I thought). Then her little brother got the conjunctivitis, was treated with the same drug for five days, and it appeared to go away. However, now my husband has it and shortly thereafter, my two children got traces of it again, and they are all on this expensive medicine (yet again) for the next five days. We do not have insurance, and this tiny bottle of medicine is $95. If I had known I had other options, I would not have given anyone anything and would have just isolated my little girl, sterilized everything, and waited for it to pass. My question now is… if after a week of using vigamox, and it returns, do I have any other option but to continue buying this expensive drug or can I wait it out? I have spoken to our pediatrician and doctor and they say we have no option.

  • Sarah Desmond, CPNP

    I Agree with Dr. Weitzner – why ARE so many people using the new drugs so much? I still use gentamycin, sulfacetamide, erythromycin for bacterial conjunctivitis. If they fail that, then I’ll culture and try something else. I have the same problem with prescribing Azithromycin for bronchitis in kids. Granted, I teach pharmacology, so I like to practice what I preach, but aren’t we just asking for drug resistance? Not to mention the cost………..

  • Dr. Weitzner

    if you notice, your comment doesn’t refute anything i wrote, which i find frustrating. i have been using sulfacetamide solution (bleph-10 is the brand) for eye infections for 15 years, and have never seen a reaction ( i like to ask patients if they have a sulfa allergy- comes in handy!). it’s very easy to treat everything with superdrugs. the skill as a clinician comes knowing when not to use them. i am happy to give my patients superdrugs when and if they really need them. explain to me why bacterial conjunctivitis, a benign, self-limited disease (that goes away even if you don’t treat it), needs a $120 bottle of superdrug vs. a $10 drug that is just as good? by the way, penicillin is about 60 years old, but is still often used in many infections ( i think it’s still drug of choice in some meningitides), since it works. that should be the measure of its worth, not its age. give this matter some serious thought, and let me know what you think.

  • R Kautz

    Are you serious? sulfa? Weren’t sulfas invented during the civil war (REALLY)?
    I like to think patients come to me for the most current treatments, not one that will cause an allergic reaction.