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Evidence summaries

Antibiotics for Acute Bacterial Conjunctivitis

Topical antibiotics appear to increase clinical and microbiological remission rates in comparison with placebo in acute bacterial conjunctivitis. Level of evidence: "B"

The quality of evidence is downgraded by study limitations(lack of/unclear allocation concealment, possible lack of blinding, and possibly selective outcome reporting).

Summary

A Cochrane review [Abstract] 1 on antibiotic therapy in the management of acute bacterial conjunctivitis included 21 trials with a total of 8 805 subjects (adults and children aged one month or older). All treatments were topical (azithromycin, besifloxacin, chloramphenicol, fusidic acid gel, gatifloxacin, levofloxacin, moxifloxacin, norfloxacin, polymyxin and bacitracin).

Antibiotics improved clinical cure (resolution of clinical symptoms or signs) by 26 % (RR 1.26, 95 % CI 1.09 to 1.46; 5 trials, n=1474) as compared with placebo. Subgroup analysis showed no differences by antibiotic class or treatment duration. In the placebo group, 55.5 % (408/735) of participants had spontaneous clinical resolution by days 4 to 9 versus 68.2 % (504/739) of participants treated with an antibiotic.

Among those who had positive microbiological culture, antibiotics increased microbiological cure (RR 1.53, 95 % CI 1.34 to 1.74; 10 trials, n=2827) as compared with placebo.

Patients receiving antibiotics had a lower risk of treatment incompletion (RR 0.64, 95 % CI 0.52 to 0.78; 13 trials, n=5573) and persistent clinical infection (RR 0.73, 95 % CI 0.65 to 0.81; 19 trials, n=5280) than those in the placebo group.

No data on the cost-effectiveness of antibiotics were found. No serious systemic side effects were reported.

    References

    • Chen YY, Liu SH, Nurmatov U, et al. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev 2023;3(3):CD001211 [PubMed]

Primary/Secondary Keywords