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

doi:10.1136/bmj.38891.551088.7C

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

Hazel A Everitt, MRC research training fellow¹, Paul S Little, professor of primary care research¹, Peter W F Smith, professor of social statistics²

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

Correspondence to: H A Everitt hae1{at}soton.ac.uk

Abstract

Objective To assess different management strategies for acuteinfective 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—immediateantibiotics (chloramphenicol eye drops; n = 104), no antibiotics(controls; n = 94), or delayed antibiotics (n = 109); a patientinformation leaflet or not; and an eye swab or not.

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

Results Prescribing strategies did not affect the severity ofsymptoms but duration of moderate symptoms was less with antibiotics:no antibiotics (controls) 4.8 days, immediate antibiotics 3.3days (risk ratio 0.7, 95% confidence interval 0.6 to 0.8), delayedantibiotics 3.9 days (0.8, 0.7 to 0.9). Compared with no initialoffer of antibiotics, antibiotic use was higher in the immediateantibiotic group: controls 30%, immediate antibiotics 99% (oddsratio 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, 1.1to 5.0), delayed antibiotics 55% (1.4, 0.7 to 3.0), and intentionto reattend for eye infections: controls 40%, immediate antibiotics68% (3.2, 1.6 to 6.4), delayed antibiotics 41% (1.0, 0.5 to2.0). A patient information leaflet or eye swab had no effecton the main outcomes. Reattendance within two weeks was lessin 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 themost appropriate strategy for managing acute conjunctivitisin primary care. It reduces antibiotic use, shows no evidenceof medicalisation, provides similar duration and severity ofsymptoms to immediate prescribing, and reduces reattendancefor eye infections.

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

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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]