Emerging Patterns of Antibiotic Resistance in Bacterial Conjunctivitis at Tertiary Hospitals in North West Nigeria

Rising antibiotic resistance among causative organisms of bacterial conjunctivitis threatens the effectiveness of empirical topical antibiotic treatment, and local resistance surveillance data are critically needed for rational antimicrobial prescribing in Nigerian ophthalmology practice. This study investigates emerging antibiotic resistance patterns in bacterial conjunctivitis at tertiary hospitals in Kano and Sokoto States, North West Nigeria. A prospective laboratory-based study will be conducted. Conjunctival swabs will be collected from consecutive patients presenting with acute purulent conjunctivitis at Aminu Kano Teaching Hospital and Usmanu Danfodiyo University Teaching Hospital. Swabs will undergo Gram stain, culture on blood and chocolate agar, organism identification using standard biochemical tests, and antimicrobial sensitivity testing using the Kirby-Bauer disc diffusion method. Minimum inhibitory concentrations will be determined for fluoroquinolones, aminoglycosides, and tetracyclines. Resistance rates per organism will be calculated and temporal trends compared with available historical data. High-income country surveillance data show increasing fluoroquinolone resistance among Staphylococcus aureus and Streptococcus pneumoniae isolates from conjunctivitis, but Nigerian data are sparse and dated. Widespread over-the-counter antibiotic use for eye infections in northern Nigeria likely accelerates resistance selection. This study provides current surveillance data to guide empirical treatment guidelines and antimicrobial stewardship policies for ophthalmology in North West Nigeria. Recommendations will include publishing local antibiograms, restricting non-prescription topical antibiotic dispensing, and training pharmacists in appropriate conjunctivitis triage. Keywords: bacterial conjunctivitis, antibiotic resistance, antimicrobial surveillance, North West Nigeria, ophthalmology