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Evidence summaries

Delayed Prescribing for Acute Conjunctivitis

Delayed prescribing of antibiotic eye drops appears to halve the use of antibiotics for acute purulent conjunctivitis, with no significant difference in symptom duration or severity compared to immediate antibiotics. Level of evidence: "B"

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).

    References

    • Everitt HA, Little PS, Smith PW. A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice. BMJ 2006 Aug 12;333(7563):321. [PubMed]

Primary/Secondary Keywords