Topical antibiotics for acute bacterial conjunctivitis: a systematic review

There has been uncertainty about whether antibiotic therapy confers signifi cant benefit in the treatment of acute bacterial conjunctivitis. This study aimed to assess the efficacy of antibiotic therapy in the management of ac ute bacterial conjunctivitis. Using standard Cochrane search methods we ide ntified double-blind randomised controlled trials in which any form of anti biotic treatment (topical, systemic or combination) had been compared with placebo in the management of acute bacterial conjunctivitis. Data extractio n and analysis followed a pre-defined protocol. Meta-analysis was performed to obtain summary measures of relative risk. Sir published trials were ide ntified of which three fulfilled the eligibility criteria for inclusion in this review. The trials were heterogeneous in terms of their inclusion and exclusion criteria, the nature of the intervention, and the outcome measure s assessed. Meta-analysis indicates that acute bacterial conjunctivitis is frequently a self-limiting condition as clinical remission occurred by days 2 to 5 in 64% (95% confidence interval (CI) = 57-71) of those heated with placebo. Treatment with antibiotics was, however associated with significan tly better rates of clinical remission (days 2 to 5 relative risk (RR) = 1. 31, 95% CI = 1.11-1.55), with a suggestion that this benefit was maintained for late clinical remission (days 6 to 10: RR = 1.27, 95% CI = 1.00-1.61). Acute bacterial conjunctivitis is frequently a self-limiting condition but the use of antibiotics is associated with significantly improved rates of early clinical remission and early and late microbiological remission. Sinc e trials to date have been conducted in selected specialist care patient po pulations, generalisation of these results to a primary care-based populati on should be undertaken with a degree of caution.