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 straight forward 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 randomized 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 concern and the current exclusion policy of many schools and nurseries for children with conjunctivitis could make implementation of a change in prescription policy difficult. An education program 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.”
Notes to editors The Medicines and Healthcare products Regulatory Agency recently announced that chloramphenicol eye drops should be available over-the-counter. It will be the first antibiotic to be sold by pharmacists without a prescription in the UK.