Tools for Practice Outils pour la pratique

#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.  

CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session

  • 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.

Latest Tools for Practice
Derniers outils pour la pratique

#367 Oral Calcitonin Gene-related Peptide Antagonists: A painfully long name for the acute treatment of migraines

What are the risks and benefits of ubrogepant for the acute treatment of episodic migraines?
Read Lire 0.25 credits available Crédits disponibles

#366 Looking for Closure: Managing simple excisions or wounds efficiently

What are some options for efficiency in wound closure?
Read Lire 0.25 credits available Crédits disponibles

#365 Shrooms for Glooms: Evidence for psilocybin for depression

What are the benefits and harms of psilocybin for treatment-resistant/recurrent depression?
Read Lire 0.25 credits available Crédits disponibles

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session

  • 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.