#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.
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EVIDENCE
- Statistically significant unless otherwise mentioned.
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- 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.
