#167 Keeping our eye on the ball for infectious conjunctivitis management
CLINICAL QUESTION
Do topical antibiotics benefit infectious conjunctivitis?
BOTTOM LINE
Nonvenereal infectious conjunctivitis is self-limited, with very low rates of complications. Topical antibiotics, compared to placebo, will lead to the resolution of symptoms in an additional ~1 in 12 patients at ~7 days. Delayed prescriptions (for three days) reduce overall antibiotic use with similar outcomes.
Reading Tools for Practice Article can earn you MainPro+ Credits
Join NowAlready a CFPCLearn Member? Log in
EVIDENCE
- Statistically significant unless otherwise mentioned.
-
- Topical antibiotics versus placebo.
- Systematic review, 11 Randomized Controlled Trials (RCTs), 3,673 patients with clinically suspected or culture confirmed bacterial conjunctivitis, (nine specialty clinics, two in primary care).1
- Clinical resolution, antibiotics versus placebo:
- At 2-5d (2,116 patients): 40% versus 30%, Number Needed to Treat (NNT)=10.
- At 6-10d (2,353 patients): 50% versus 41%, NNT=12.
- Clinical resolution, antibiotics versus placebo:
- Systematic review, three primary care RCTs, 622 patients with clinically suspected infectious conjunctivitis.2
- Cure rate at day seven, antibiotics versus placebo:
- 80% versus 74%, NNT=17.
- When no treatment is used (instead of placebo drops) greater absolute benefit are seen with antibiotics.3
- Cure rate at day seven, antibiotics versus placebo:
- Systematic review, 11 Randomized Controlled Trials (RCTs), 3,673 patients with clinically suspected or culture confirmed bacterial conjunctivitis, (nine specialty clinics, two in primary care).1
- Delayed versus immediate antibiotics versus no prescription.3
- Primary care RCT, 307 patients with clinically suspected infectious conjunctivitis.
- Mean duration of moderate symptoms 4.8 days if no prescription.
- Decreased by 1.5 days if immediate antibiotics.
- Decreased by 0.9 day if delayed antibiotics.
- Antibiotics were used by: 99% receiving immediate antibiotics, 53% delayed (three days), 30% no prescription.
- No difference in symptom scores on days 1-3 following consultation.
- Topical antibiotics versus placebo.
- The two main primary care RCTs used “infectious/acute conjunctivitis” as their inclusion criteria, suggesting that making a diagnosis of bacterial conjunctivitis (versus viral) is not essential when deciding to prescribe (or not) antibiotic drops.3,4
- No complications of acute bacterial conjunctivitis were reported in a systematic review of 11 RCTs.1
- Evidence does not demonstrate clear superiority of one topical antibiotic over another,1,5 therefore practical considerations such as dosing and cost should be considered if antibiotics are prescribed.
Latest Tools for Practice
#378 Tony Romo-sozumab: Winning touchdown in osteoporosis or interception for the loss?
What is the efficacy and safety of romosozumab in postmenopausal women with osteoporosis?
#377 How to slow the flow IV: Combined oral contraceptives
In premenopausal heavy menstrual bleeding due to benign etiology, do combined oral contraceptives (COC) improve patient outcomes?
#376 Testosterone supplementation for cis-gender men: Let’s (andro-)pause for a moment (Update)
What are the benefits and harms of testosterone supplementation in healthy cis-gender men or those with age-related low testosterone?
