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#167 Keeping our eye on the ball for infectious conjunctivitis management

Do topical antibiotics benefit infectious conjunctivitis?

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.  

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  • 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.
      • 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  
    • 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. 
  • 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.

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  • Christina Korownyk MD CCFP
  • Emelie Braschi MD

1. Sheikh A, Hurwitz B, van Schayck CP, et al., Cochrane Database Syst Rev., 2012, (9) : CD001211.

2. Jefferis J, Perera R, Everitt H, et al., Br J Gen Pract., 2011, 61 : e542-548.

3. Everitt HA, Little PS, Smith PW, BMJ, 2006, 333(7563) : 321.

4. Rose PW, Harnden A, Brueggemann AB, et al., Lancet, 2005, 366 : 37-43.

5. Epling J, BMJ Clin Evid., 2012, le 20 février 2012.

Authors do not have any conflicts to disclose.