Value of antibiotic is queried by research

Most children with infective conjunctivitis do not need treatment with an antibiotic, a study in The Lancet this week has suggested.

The news follows latest changes allowing optometrists to supply over the counter antibiotic preparations.

And it coincides with this month's announcement by the Medicines and Healthcare products Agency (MHRA) enabling Chloramphenicol eye drops to be sold over the counter by pharmacists - the first antibiotic to be sold by chemists without a prescription in this country (News, June 17).

The Lancet article (Chloramphenicol treatment for acute infective conjunctivitis in children in primary care: a randomised double-blind placebo-controlled trial) reports research that believes parents should be encouraged to treat the children themselves without medical consultation, unless their child develops unusual symptoms, or the symptoms persist for more than a week.

Led by Dr Peter Rose, retaining fee lecturer at the Department of Primary Health Care, University of Oxford, the team carried out 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 during 2001-2004.

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 seven days. The study discovered that 86 per cent of the children were clinically cured in the antibiotic group compared with 83 per cent in the placebo group.

Even in children who had a bacterial infection, the clinical cure rate did not differ significantly between the antibiotic (85 per cent) and the placebo groups (80 per cent).

Dr Rose said: '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 one million general practice consultations and antibiotic prescriptions every year is substantial.

'However, parental concern and current exclusion policy of many schools and nurseries for children with conjunctivitis could make implementation of a change in prescription policy difficult.

'An education programme and change in school policy to reflect national public health advice might be needed before family doctors can realistically achieve a reduction in antibiotic prescriptions.'

One in eight school children suffers from an episode of conjunctivitis every year - this amounts to more than one million episodes in the UK. Diagnosis is normally 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 scare.

Authors of the report in The Lancet point out that antibiotic resistance is a growing global problem.