BACKGROUND: Acute infective conjunctivitis is a common problem in primary care, traditionally managed with topical antibiotics. A number of clinical trials have questioned the benefit of topical antibiotics for patients with acute infective conjunctivitis. AIM: To determine the benefit of antibiotics for the treatment of acute infective conjunctivitis in primary care and which subgroups benefit most. DESIGN: An individual patient data meta-analysis. METHOD: Relevant trials were identified and individual patient data gathered for meta-analysis and subgroup analysis. RESULTS: Three eligible trials were identified. Individual patient data were available from all primary care trials and data were available for analysis in 622 patients. Eighty per cent (246/308) of patients who received antibiotics and 74% (233/314) of controls were cured at day 7. There was a significant benefit of antibiotics versus control for cure at seven days in all cases combined (risk difference 0.08, 95% confidence interval (CI) = 0.01 to 0.14). Subgroups that showed a significant benefit from antibiotics were patients with purulent discharge (risk difference 0.09, 95% CI = 0.01 to 0.17) and patients with mild severity of red eye (risk difference 0.10, 95% CI = 0.02 to 0.18), while the type of control used (placebo drops versus nothing) showed a statistically significant interaction (P=0.03). CONCLUSION: Acute conjunctivitis seen in primary care can be thought of as a self-limiting condition, with most patients getting better regardless of antibiotic therapy. Patients with purulent discharge or a mild severity of red eye may have a small benefit from antibiotics. Prescribing practices need to be updated, taking into account these results.
BACKGROUND:Acute infective conjunctivitis is a common problem in primary care, traditionally managed with topical antibiotics. A number of clinical trials have questioned the benefit of topical antibiotics for patients with acute infective conjunctivitis. AIM: To determine the benefit of antibiotics for the treatment of acute infective conjunctivitis in primary care and which subgroups benefit most. DESIGN: An individual patient data meta-analysis. METHOD: Relevant trials were identified and individual patient data gathered for meta-analysis and subgroup analysis. RESULTS: Three eligible trials were identified. Individual patient data were available from all primary care trials and data were available for analysis in 622 patients. Eighty per cent (246/308) of patients who received antibiotics and 74% (233/314) of controls were cured at day 7. There was a significant benefit of antibiotics versus control for cure at seven days in all cases combined (risk difference 0.08, 95% confidence interval (CI) = 0.01 to 0.14). Subgroups that showed a significant benefit from antibiotics were patients with purulent discharge (risk difference 0.09, 95% CI = 0.01 to 0.17) and patients with mild severity of red eye (risk difference 0.10, 95% CI = 0.02 to 0.18), while the type of control used (placebo drops versus nothing) showed a statistically significant interaction (P=0.03). CONCLUSION: Acute conjunctivitis seen in primary care can be thought of as a self-limiting condition, with most patients getting better regardless of antibiotic therapy. Patients with purulent discharge or a mild severity of red eye may have a small benefit from antibiotics. Prescribing practices need to be updated, taking into account these results.
Authors: Paul Karpecki; Michael Depaolis; Judy A Hunter; Eric M White; Lee Rigel; Lynne S Brunner; Dale W Usner; Michael R Paterno; Timothy L Comstock Journal: Clin Ther Date: 2009-03 Impact factor: 3.393
Authors: Michael E Tepedino; Warren H Heller; Dale W Usner; Lynne S Brunner; Timothy W Morris; Wolfgang Haas; Michael R Paterno; Timothy L Comstock Journal: Curr Med Res Opin Date: 2009-05 Impact factor: 2.580
Authors: Mark B Abelson; Warren Heller; Aron M Shapiro; Erwin Si; Peng Hsu; Lyle M Bowman Journal: Am J Ophthalmol Date: 2008-03-28 Impact factor: 5.258