A cohort study 1 in 25 Dutch health centres included 184 patients at least 18 years of age with a red eye and either (muco)purulent discharge or sticking of the eyelids. Patients with pre-existing symptoms for longer than seven days, acute loss of vision, wearing of contact lenses, use of systemic or local antibiotic within the previous two weeks, ciliary redness, eye trauma, and a history of eye surgery. The gold standard for bacterial conjunctivitis was positive bacterial culture. The combination of early morning glued eye(s), the absence of itch and the absence of a history of conjunctivitis had an area under the receiver operating characteristics curve of 0.74 (95% CI 0.63 to 0.80). The overall prevalence of bacterial involvement of 32% could be lowered to 4% or raised to 77% depending on the pattern of index test results. A score system was developed using the logistic regression model: The scores of independent indicators of positive bacterial culture to be added up were: two glued eyes, 5; one glued eye, 2; itching, -1; history of conjunctivitis, -2. Using the total score of +2 as treatment treshold would reduce antibiotic prescriptions from more than 80% to 40%.
Primary/Secondary Keywords