BMJ  2006;333:321 (12 August), doi:10.1136/bmj.38891.551088.7C (published 17 July 2006)

Research

A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice

¹ Primary Medical Care, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, ² Southampton Statistical Sciences Research Institute, University of Southampton

Abstract

Objective To assess different management strategies for acute infective conjunctivitis.

Design Open, factorial, randomised controlled trial.

Setting 30 general practices in southern England.

Participants 307 adults and children with acute infective conjunctivitis.

Intervention One of three antibiotic prescribing strategies—immediate antibiotics (chloramphenicol eye drops; n = 104), no antibiotics (controls; n = 94), or delayed antibiotics (n = 109); a patient information leaflet or not; and an eye swab or not.

Main outcome measures Severity of symptoms on days 1-3 after consultation, duration of symptoms, and belief in the effectiveness of antibiotics for eye infections.

Results Prescribing strategies did not affect the severity of symptoms but duration of moderate symptoms was less with antibiotics: no antibiotics (controls) 4.8 days, immediate antibiotics 3.3 days (risk ratio 0.7, 95% confidence interval 0.6 to 0.8), delayed antibiotics 3.9 days (0.8, 0.7 to 0.9). Compared with no initial offer of antibiotics, antibiotic use was higher in the immediate antibiotic group: controls 30%, immediate antibiotics 99% (odds ratio 185.4, 23.9 to 1439.2), delayed antibiotics 53% (2.9, 1.4 to 5.7), as was belief in the effectiveness of antibiotics: controls 47%, immediate antibiotics 67% (odds ratio 2.4, 1.1 to 5.0), delayed antibiotics 55% (1.4, 0.7 to 3.0), and intention to reattend for eye infections: controls 40%, immediate antibiotics 68% (3.2, 1.6 to 6.4), delayed antibiotics 41% (1.0, 0.5 to 2.0). A patient information leaflet or eye swab had no effect on the main outcomes. Reattendance within two weeks was less in the delayed compared with immediate antibiotic group: 0.3 (0.1 to 1.0) v 0.7 (0.3 to 1.6).

Conclusions Delayed prescribing of antibiotics is probably the most appropriate strategy for managing acute conjunctivitis in primary care. It reduces antibiotic use, shows no evidence of medicalisation, provides similar duration and severity of symptoms to immediate prescribing, and reduces reattendance for eye infections.

Trial registration Current Controlled Trials ISRCTN32956955 [controlled-trials.com] .

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

This article has been cited by other articles:

• Tellegen, E, ter Riet, G, Sloos, J H, van Weert, H C P M (2009). Diagnosis of conjunctivitis in primary care: comparison of two different culture procedures. J. Clin. Pathol. 62: 939-941 [Abstract] [Full text]  
• Knights, G. (2009). Audit of management of acute infective conjunctivitis in primary care. InnovAiT 2: 59-64 [Abstract] [Full text]  
• Everitt, H. (2009). Acute conjunctivitis. InnovAiT 2: 44-49 [Abstract] [Full text]  
• (2008). EMQ answers. Emerg. Med. J. 25: 183-183 [Full text]  
• Fiscella, R. G., Lewis, C. C., Jensen, M. K. (2007). Topical ophthalmic fourth-generation fluoroquinolones: Appropriate use and cost considerations. Am J Health Syst Pharm 64: 2069-2073 [Abstract] [Full text]  
• Fleming, D. M. (2007). The state of play in the battle against antimicrobial resistance: a general practitioner perspective. J Antimicrob Chemother 60: i49-i52 [Abstract] [Full text]  
• Qureshi, K. M, Robbie, S., Kashani, S., Rose, P. (2007). Viral infections need to be excluded from the cohort for the results to be truly meaningful * Author's reply. Evid. Based Med. 12: 93-93 [Full text]  
• (2007). Avoiding antibacterial overuse in primary care. DTB 45: 25-29 [Abstract] [Full text]  
• Renouf, P. (2007). Immediate or delayed prescribing of antibiotics reduced duration of symptoms in acute infective conjunctivitis. Evid. Based Nurs. 10: 10-10 [Full text]  
• Larcombe, J. (2006). Review: antibiotic therapy leads to slightly earlier recovery in acute bacterial conjunctivitis. Evid. Based Med. 11: 180-180 [Full text]  
• Baron, T., Wallis, L. (2006). Sophia. Emerg. Med. J. 23: 960-960 [Full text]  
• (2006). Antibiotics for Conjunctivitis: OK to Delay?. JWatch Emergency Med. 2006: 4-4 [Full text]  
• Nelson, M. R (2006). Managing conjunctivitis in general practice: recommendations depend on health system.. BMJ 333: 446-446 [Full text]  
• Robbie, S. J, Qureshi, K., Kashani, S., Qureshi, M. A (2006). Managing conjunctivitis in general practice: research into management strategies for acute infective conjunctivitis.. BMJ 333: 446-447 [Full text]  
• Rietveld, R. P, Bindels, P. J E, ter Riet, G. (2006). Antibiotics for upper respiratory tract infections and conjunctivitis in primary care. BMJ 333: 311-312 [Full text]  

Rapid Responses:

Read all Rapid Responses

Acute infective conjunctivitis - a Primary eye care perspective

Terrence Soong, et al.
bmj.com, 19 Jul 2006 [Full text]

Authors Response

Hazel A. Everitt
bmj.com, 21 Jul 2006 [Full text]

Research into management strategies for acute infective conjuntivitis in general practice.

Scott J Robbie, et al.
bmj.com, 11 Aug 2006 [Full text]

Infective conjunctivitis: a review

Tanya N Moutray
bmj.com, 11 Aug 2006 [Full text]

Response to Everitt, Little and Smith

C Steven Bailey
bmj.com, 11 Aug 2006 [Full text]

Infective conjunctivitis? Are you sure ?

Jonathan Lochhead
bmj.com, 12 Aug 2006 [Full text]

Risks with delayed prescribing in apparent acute bacterial conjunctivitis

MOHAMMAD T MASOUD
bmj.com, 13 Aug 2006 [Full text]

What about working parents?

chris harnden
bmj.com, 14 Aug 2006 [Full text]

A Missed Opportunity ?

Dr Haider Bhogadia
bmj.com, 14 Aug 2006 [Full text]

Can GPs differentiate eye anomalies? - patient's experience

Phillip J. Colquitt
bmj.com, 14 Aug 2006 [Full text]

Conjuctivitis in young children

M. Ashwin Reddy
bmj.com, 14 Aug 2006 [Full text]

Chloramphenicol – a panacea for all ophthalmic problems?

Jonathan Goodfellow, et al.
bmj.com, 14 Aug 2006 [Full text]

The red eye

Jan Matthys
bmj.com, 14 Aug 2006 [Full text]

Time to reconsider prescribing strategy in the primary care?

Deepa R Anijeet
bmj.com, 15 Aug 2006 [Full text]

Recommendations are health system dependent

Mark R Nelson
bmj.com, 15 Aug 2006 [Full text]

Authors Response

Hazel A. Everitt
bmj.com, 23 Aug 2006 [Full text]

Topical chloramphenicol is a safe, effective, and inexpensive treatment for bacterial conjunctivitis

Anthony P Khawaja, et al.
bmj.com, 9 Sep 2006 [Full text]

Response to Everitt, Little and Smith

David W McKeag
bmj.com, 21 Sep 2006 [Full text]

Re: Topical chloramphenicol is a safe, effective, and inexpensive treatment for bacterial conjunctivitis

Anthony P Khawaja, et al.
bmj.com, 6 Oct 2006 [Full text]

Authors Response

Hazel A. Everitt, et al.
bmj.com, 11 Oct 2006 [Full text]