Topical Antibiotics for Clinical and Microbiological Cure of Bacterial Conjunctivitis

Abstract

Acute bacterial conjunctivitis is an infective condition frequently resulting in mucopurulent ocular discharge, bulbar and palpebral injection, and discomfort.. It may be difficult to differentiate between viral and bacterial conjunctivitis on clinical grounds, and swabbing eyes for cultures is not considered clinically practical. Therefore, although most cases are self‐limited, antibiotics are typically given based on the belief that they decrease time to recovery, reduce sight‐threatening complications, and reduce the rate of relapse.

This review, an update of a previous Cochrane review from 2006, included 11 randomized control trials totaling 3673 patients with bacterial conjunctivitis, whereas the prior review included five randomized control trials and 1034 patients. The review included trials that made the diagnosis of bacterial conjunctivitis based on either clinical or microbiological grounds.¹ Clinical criteria required varied but generally included ocular discharge and conjunctival injection. Two of the trials required microbiologically proven bacterial conjunctivitis with the remainder making the diagnosis on clinical grounds. The primary outcomes of this review included both clinical and microbiological cure rates.¹ How cure was assessed varied between trials but in general, it was defined by absence of symptoms or microbiological eradication.

Data analysis from the trials indicated improved early (2‐5 day) clinical cure rate of 40% (risk ratio (RR) 1.36, 95% confidence interval (CI), 1.15 to 1.61) and microbiological cure (RR 1.55, 95% CI, 1.37 to 1.76). At 6 to 10 days (considered the 'late' time point) antibiotics continued to show clinical benefit in clinical and microbiological cure (RR 1.21, 95% CI, 1.10 to 1.33 and RR 1.37, 95% CI, 1.24 to 1.52 respectively). The absolute risk difference for early and late clinical cure were 11% and 9%, respectively, corresponding to an NNT of 9 and 11.¹

Among subjects in the placebo groups, 30% achieved clinical cure by day 5, and 41% of cases had resolved by day 6‐10. No serious outcomes were reported in either placebo groups or treatment groups.

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