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Antibiotics decrease symptom duration for conjunctivitis.

* Clinical Question

In adults or children with acute infective conjunctivitis, are antibiotics effective in decreasing the length and severity of symptoms?

* Bottom Line

Treatment with an antibiotic, either immediately or after 3 days without symptom improvement, shortened the duration of acute conjunctivitis but did not decrease the severity of symptoms. Delaying the antibiotic reduced the need for antibiotics by almost 50% with similar symptom control and no more repeat visits than immediate antibiotic use. These results were the same for conjunctivitis with and without an identified bacterial cause. (Level of evidence [LOE]: 1b)

Study Design

Meta-analysis (randomized controlled trials)


Self-funded or unfunded


Outpatient (any)


The investigators enrolled 307 adults and children seen in 30 general practices in England who presented with uncomplicated acute infective conjunctivitis. The patients were randomly assigned, using concealed allocation, to receive immediate antibiotic treatment with chloramphenicol eye drops, delayed antibiotic treatment, or no treatment. The delayed antibiotic treatment was a prescription for chloramphenicol that could be picked up if symptoms were not better after 3 days, which occurred 53% of the time.

The main outcomes of this study were the duration of moderately bad symptoms, average severity score for the 3 days following diagnosis, and belief in the effectiveness of antibiotics. The duration of moderate symptoms was shorter for both the immediate antibiotic group and the delayed antibiotic group: 3.3 days and 3.9 days, respectively, versus 4.8 days. The average severity of symptoms on days 1 to 3 did not differ among the groups. Approximately half the patients were cultured for the presence of bacteria, and significant bacterial growth was found in 50%. However, the duration and severity of symptoms was not different in patients with bacterial infection and those without. Nine percent of patients returned within 2 weeks; significantly fewer patients in the delayed antibiotic group returned within 2 weeks. Patients receiving immediate antibiotic treatment were more likely than patients not receiving treatment to believe antibiotics were effective (number needed to treat=5). This belief could have lead these patients to underestimate their symptoms, which might have been responsible for the shorter duration. A better way to control for this belief would be to use placebo eye drops instead of no eye drops.


Delaying antibiotics reduced the need for them by almost 50%, with similar symptom control

Everitt HA, Little PS, Smith PW. A randomised controlled trial of management strategies for acute conjunctivitis in general practice. BMJ 2006; 333:321-326.

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Article Details
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Title Annotation:Patient Oriented Evidence that Matters
Author:Everitt, H.A.; Little, P.S.; Smith, P.W.
Publication:Journal of Family Practice
Date:Dec 1, 2006
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