Delaying antibiotic treatment of conjunctivitis is the best strategy

Delayed prescribing of antibiotics may be the most appropriate way of managing acute conjunctivitis, according to the results of a study published in the British Medical Journal.

Hazel Everitt and colleagues from the University of Southampton, UK, conducted an open, factorial, randomised controlled trial of 307 adults and children with acute infective conjunctivitis at 30 general practices in Southern England. Three antibiotic prescribing strategies were used; immediate antibiotics (chloramphenicol eye drops, n=104), no antibiotics (controls, n=94) or delayed antibiotics (n=109). In addition, patients were either given an information leaflet or not and an eye swab or not. Outcome measurements included the severity of symptoms on days 1-3 after consultation, duration of symptoms and belief in the effectiveness of antibiotics for eye infections.

Prescribing strategies did not affect the severity of symptoms but duration of moderate symptoms was less with antibiotics: no antibiotics 4.8 days, immediate antibiotics 3.3 days, delayed antibiotics 3.9 days. Compared with no initial offer of antibiotics, antibiotic use was higher in the immediate antibiotic group: controls 30%, immediate antibiotics 99% and delayed antibiotics 53%. The same was true of the belief in the effectiveness of antibiotics. Patient information leaflets and eye swabs had no effect on the main outcomes. Re-attendance within two weeks was less in the delayed compared with the immediate antibiotic group.

The authors concluded that the delayed prescribing of antibiotics for acute conjunctivits is probably the most effective management strategy as it reduces antibiotic use, shows no evidence of medicalisation, offers similar duration and severity of symptoms to immediate prescribing and reduces re-attendance for eye infections.