Antibiotics versus placebo for acute bacterial conjunctivitis

Sheikh A, Hurwitz B

Published Online:

January 21, 2009

Acute bacterial conjunctivitis is an infective condition in which the eyes become red and inflamed. The condition is not normally serious and usually recedes spontaneously within about a week. People with acute conjunctivitis are often given antibiotics, usually as eye drops or ointment, to speed recovery. The benefits of antibiotics to the sufferer of conjunctivitis have been questioned. The review of trials found that the signs of conjunctivitis went away more quickly in people taking antibiotics, but the benefits are marginal as in most cases the infection is self-limiting.

Abstract (click to read)

Background:

There are concerns about whether antibiotic therapy confers significant clinical benefit in the treatment of acute bacterial conjunctivitis.

Objectives:

The aim of this review was to assess the benefit and harm of antibiotic therapy in the management of acute bacterial conjunctivitis.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register), MEDLINE, EMBASE, SIGLE, NRR, PubMed and the reference lists of identified trial reports. We used the Science Citation Index to look for articles that cited the relevant studies, and we contacted investigators and pharmaceutical companies for information about additional trials.

Selection criteria:

We included double masked randomised controlled trials in which any form of antibiotic treatment had been compared with placebo in the management of acute bacterial conjunctivitis. This included topical, systemic and combination (for example, antibiotics and steroids) antibiotic treatments.

Data collection and analysis:

One author extracted data and the accuracy was checked by a second author.

Main results:

This review includes five trials which randomised a total of 1034 participants. One further trial is currently 'awaiting assessment'. This has been published in abstract form and has yet to be fully reported. Three of the trials have been conducted on a selected specialist care patient population and the two more recent trials have been conducted in a community care setting. The trials were heterogeneous in terms of their inclusion and exclusion criteria, the nature of the intervention, and the outcome measures assessed. Meta-analyses of data on clinical and microbiological remission rates reveal that topical antibiotics are of benefit in improving early (days 2 to 5) clinical (RR 1.24, 95% CI 1.05 to 1.45) and microbiological (RR 1.77, 95% CI 1.23 to 2.54) remission rates; later (days 6 to 10) data reveal that these early advantages in clinical (RR 1.11, 95% CI 1.02 to 1.21) and microbiological cure rates are reduced (RR 1.56, 95% CI 1.17 to 2.09), but persist. Most cases however resolve spontaneously with clinical remission being achieved in 65% (95% CI 59 to 70) by days 2 to 5 in those receiving placebo. No serious outcomes were reported in either the active or placebo arms of these trials, indicating that important sight-threatening complications are an infrequent occurrence.

Authors' conclusions:

Acute bacterial conjunctivitis is frequently a self-limiting condition, but the use of antibiotics is associated with significantly improved rates of clinical and microbiological remission.

This record should be cited as:

Sheikh A, Hurwitz B. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD001211. DOI: 10.1002/14651858.CD001211.pub2

Assessed as up to date:

October 25, 2007

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Primary Review Group:

Eyes and Vision Group

Health topics:

Infectious disease > Eye diseases > Conjunctivitis

Eyes & vision > Conjunctival disease

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Antibiotics versus placebo for acute bacterial conjunctivitis

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