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Antibiotics for conjunctivitis 'of benefit in some patients'

GPs have been urged to use topical antibiotics in only a small subset of patients with acute infective conjunctivitis, by the authors of a new general practice study.

The study published in the British Journal of General Practice this month found that though topical antibiotics are of limited benefit in most patients, those with purulent discharge or mild red eye may show more significant benefits.

The meta-analysis of individual patient data from three trials of 622 patients in primary care setting found there was a small but significant overall benefit to using antibiotics for acute conjunctivitis – 80% of patients who received antibiotics were cured by day seven compared with 74% of controls in a primary care setting. The number needed to treat was 13.

The researchers concluded that patients with purulent discharge or with mild red eye gained a more significant benefit from antibiotics - with a risk difference of 0.09 and 0.10 and a number needed to treat of 12 and 10 respectively.

Current guidelines suggest prescribing antibiotics where the conjunctivitis is severe, or in children where they may be excluded from school or child care.

Study leader Dr Joanna Jefferis, a research fellow in ophthalmology at Newcastle University, said: ‘Most patients recovered by day seven whether they received antibiotics or not.'

But she added: ‘It is also important to know whether antibiotics may shorten the duration of symptoms. There is a limited set of patients who may benefit from antibiotics, including patients with purulent discharge and patients with mild severity of red eye. However, even in these groups the benefit of antibiotics is limited.'

‘Judicious use of antibiotics is important to reduce the risks of antibiotic resistance in the population.'

'Prescribing practices and over-the-counter policies need to be updated to reflect these findings. Furthermore, patient expectations of antibiotic use need to be addressed, as they are likely to be a strong driving force behind prescribing decisions.'

Professor Paul Little, professor of primary care research at the University of Southampton said: ‘GPs should aim for regular washing of eyes and consider using the delayed prescribing approach.'

BGJP 2011; 61: e542-e548

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