Antibiotics not always necessary for conjunctivitis says Lancet

Most children with infective conjunctivitis (pinkeye) do not need treatment with an
antibiotic, suggests a study published online today (Wednesday June 22, 2005) by The Lancet.
One in eight school children have an episode of conjunctivitis every year. This amounts to
more than 1 million episodes in the UK and more than 5 million in the USA. Diagnosis of the
condition is usually straightforward but doctors find difficulty in differentiating a viral cause
from a bacterial cause. Standard practice is to prescribe antibiotic eye drops, although
evidence to support this decision is scarce. Antibiotic resistance is also a growing global
problem, state the authors.
Peter Rose (University of Oxford, UK) and colleagues did a randomised trial to investigate the
effectiveness of an antibiotic treatment when compared with a placebo. Over 300 children
were recruited onto the study from 12 medical practices in Oxfordshire UK, from 2001 to
2004. Half were assigned to chloramphenicol eye drops—the most commonly used antibiotic
for conjunctivitis in the UK—and half to placebo eye drops. The investigators found no
significant difference in the cure rate after 7 days. 86% of the children were clinically cured in
the antibiotic group compared with 83% in the placebo group. Even in children who had a
bacterial infection, the clinical cure rate did not differ significantly between the antibiotic
(85%) and the placebo groups (80%). The researchers suggest parents should be encouraged
to treat children themselves without medical consultation, unless their child develops
unusual symptoms or the symptoms persist for more than a week.
Dr Rose states: “We have shown that symptoms resolve without antibiotics in most children
with acute infective conjunctivitis . . . The health economic argument against antibiotic
prescription for acute conjunctivitis is compelling. The cost of 1 million general practice
consultations and antibiotic prescriptions every year is substantial. However, parental


peter.rose@dphpc.ox.ac.uk