An RCT performed in 30 English general practices 1 compared three prescribing strategies for acute purulent conjunctivitis in 307 adults and children: immediate antibiotics (chloramphenicol eye drops; n = 104), no antibiotics (controls; n = 94), or delayed antibiotics (n = 109). Prescribing strategies did not affect the severity of symptoms on day 1-3, but duration of moderate symptoms was less with antibiotics: no antibiotics (controls) 4.8 days, immediate antibiotics 3.3 days (risk ratio 0.7, 95% CI 0.6 to 0.8), delayed antibiotics 3.9 days (0.8, 0.7 to 0.9). Antibiotic use was higher in the immediate antibiotic group: controls 30%, immediate antibiotics 99% (odds ratio 185.4, 23.9 to 1439.2), delayed antibiotics 53% (2.9, 1.4 to 5.7). Reattendance within two weeks was less in the delayed compared with immediate antibiotic group: 0.3 (0.1 to 1.0) v 0.7 (0.3 to 1.6).
Comment: The quality of evidence is downgraded by imprecise results (limited study size).
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