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Three Part Question

In [patients with acute bacterial conjunctivitis] is [the use of topical antibiotic therapy better than placebo] at [reducing the time to clinical remission]?

Clinical Scenario

One evening after the emergency eye centre has closed you assess a patient and diagnose acute bacterial conjunctivitis. Your usual practice is to prescribe topical antibiotic therapy. Having recently attended a BestBETs course you wonder if this has been shown to reduce the time to clinical remission.

Search Strategy

Medline 1966-04/02 using the OVID interface, Cochrane Library Issue 1, 2002.
Medline: (exp Chloramphenicol OR chloramphenicol.af OR exp Chlortetracycline OR chlortetracycline.af OR exp Ciprofloxacin OR ciprofloxacin.af OR exp Framycetin OR framycetin.af OR exp Fusidic acid OR fusidic acid.af OR exp Gentamicins OR gentamicin.af OR exp Neomycin OR neomycin.af OR exp Ofloxacin OR ofloxacin.af OR exp Polymyxin B OR polymyxin.af OR lomefloxacin.af OR propamidine.af OR exp Anti-Infective agents OR anti-infective agent$.af OR antib$.af) AND (exp Conjunctivitis OR conjunctiv$.af) AND maximally sensitive RCT filter AND (LIMIT to human AND English). Cochrane: (CONJUNCTIVITIS, BACTERIAL) AND (ANTIBIOTICS)

Search Outcome

1231 papers were found of which 3 were relevant and had been meta-analysed by the Cochrane Eyes and Vision Group. This review was last updated on the 27th October 1999. No further relevant papers were identified after this date.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Sheikh A et al, 1999, UK	527 patients, from 3 studies, with acute bacterial conjunctivitis randomised to receive either topical antibiotic preparation or placebo	Meta-analysis	Late (days 6-10) clinical remission	RR 1.27 (99% CI 0.92 – 1.74)	Inclusion criteria of swab proven acute bacterial conjunctivitis in only 2 of the 3 studies Different topical antibiotic preparations in each of the 3 studies Selected specialist care patient populations
			Early (days 2-5) clinical remission	RR 1.31 (99% CI 1.11 – 1.55)

Comment(s)

The meta-analysis indicates that acute bacterial conjunctivitis is frequently a self-limiting condition, as early (days 2-5) clinical remission occurred in 64% (95% CI 57% - 71%) of those treated with placebo.

Clinical Bottom Line

The use of topical antibiotic therapy does reduce the time to clinical remission in patients with acute bacterial conjunctivitis.

Level of Evidence

Level 2 - Studies considered were neither 1 or 3.

References

1. Sheikh A, Hurwitz B, Cave J. Antibiotics versus placebo for acute bacterial conjunctivitis (Cochrane Review). The Cochrane Library Issue 1, 2002. Oxford: Update Software.