Acute infective conjunctivitis in primary care: Who needs antibiotics? An individual patient data meta-analysis

Jefferis, Joanna, Perera, Rafael, Everitt, Hazel, van Weert, Henk, Rietveld, Remco, Glasziou, Paul and Rose, Peter (2011) Acute infective conjunctivitis in primary care: Who needs antibiotics? An individual patient data meta-analysis. British Journal of General Practice, 61 (590), e545-e548. (doi:10.3399/bjgp11X593811). (PMID:22152728)

Abstract

Background: acute infective conjunctivitis is a common problem in primary care, traditionally managed with topical antibiotics. A number of clinical trials have questioned the benefit of topical antibiotics for patients with acute infective conjunctivitis

Aim: to determine the benefit of antibiotics for the treatment of acute infective conjunctivitis in primary care and which subgroups benefit most

Design: an individual patient data meta-analysis

Method: relevant trials were identified and individual patient data gathered for meta-analysis and subgroup analysis

Results: three eligible trials were identified. Individual patient data were available from all primary care trials and data were available for analysis in 622 patients. Eighty per cent (246/308) of patients who received antibiotics and 74% (233/314) of controls were cured at day 7. There was a significant benefit of antibiotics versus control for cure at seven days in all cases combined (risk difference 0.08, 95% confidence interval (CI) = 0.01 to 0.14). Subgroups that showed a significant benefit from antibiotics were patients with purulent discharge (risk difference 0.09, 95% CI = 0.01 to 0.17) and patients with mild severity of red eye (risk difference 0.10, 95% CI = 0.02 to 0.18), while the type of control used (placebo drops versus nothing) showed a statistically significant interaction (P=0.03)

Conclusion: acute conjunctivitis seen in primary care can be thought of as a self-limiting condition, with most patients getting better regardless of antibiotic therapy. Patients with purulent discharge or a mild severity of red eye may have a small benefit from antibiotics. Prescribing practices need to be updated, taking into account these results

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Contributors

Author: Hazel Everitt

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