Conjunctivitis ============== Chlamydial Conjunctivitis þ Give antibiotics? thennt.com says yes - In Summary, for those who took the antibiotics: 85% saw no benefit 15% were helped by being clinically cured within 2 to 5 days of treatment 0% were harmed by medication adverse reactions In Other Words: 1 in 7 were helped (clinical cure at 2-5 days) None were harmed (medication adverse reaction) (based on the Cochrane review0 þ Do antibiotics help conjunctivitis? - No. We do it out of habit and because we're afraid not to do it and, besides, we have to do "something." + 3 randomized controlled trials: 527 patients with conjunctivitis treated by ophthalmologists (referral bias - probably worse than we see) + Placebo: 64% better at 2 - 5 days + Antibiotic: minor clinical benefit at 2 - 5 days, but no difference in healing or symptoms at 6 - 10 days + No major complications reported in either group - Maybe: [Sheikh, A. and B. Hurwitz (2006) Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database of Systematic Reviews DOI: 10.1002/14651858.CD001211.pub2] BACKGROUND: There are concerns about whether antibiotic therapy confers significant clinical benefit in the treatment of acute bacterial conjunctivitis. OBJECTIVES: The aim of this review was to assess the benefit and harm of antibiotic therapy in the management of acute bacterial conjunctivitis. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register), MEDLINE, EMBASE, SIGLE, NRR, PubMed and the reference lists of identified trial reports. We used the Science Citation Index to look for articles that cited the relevant studies, and we contacted investigators and pharmaceutical companies for information about additional trials. SELECTION CRITERIA: We included double masked randomised controlled trials in which any form of antibiotic treatment had been compared with placebo in the management of acute bacterial conjunctivitis. This included topical, systemic and combination (for example, antibiotics and steroids) antibiotic treatments. DATA COLLECTION AND ANALYSIS: One author extracted data and the accuracy was checked by a second author. MAIN RESULTS: This review includes five trials which randomised a total of 1034 participants. One further trial is currently 'awaiting assessment'. This has been published in abstract form and has yet to be fully reported. Three of the trials have been conducted on a selected specialist care patient population and the two more recent trials have been conducted in a community care setting. The trials were heterogeneous in terms of their inclusion and exclusion criteria, the nature of the intervention, and the outcome measures assessed. Meta-analyses of data on clinical and microbiological remission rates reveal that topical antibiotics are of benefit in improving early (days 2 to 5) clinical (RR 1.24, 95% CI 1.05 to 1.45) and microbiological (RR 1.77, 95% CI 1.23 to 2.54) remission rates; later (days 6 to 10) data reveal that these early advantages in clinical (RR 1.11, 95% CI 1.02 to 1.21) and microbiological cure rates are reduced (RR 1.56, 95% CI 1.17 to 2.09), but persist. Most cases however resolve spontaneously with clinical remission being achieved in 65% (95% CI 59 to 70) by days 2 to 5 in those receiving placebo. No serious outcomes were reported in either the active or placebo arms of these trials, indicating that important sight-threatening complications are an infrequent occurrence. AUTHORS' CONCLUSIONS: Acute bacterial conjunctivitis is frequently a self- limiting condition, but the use of antibiotics is associated with significantly improved rates of clinical and microbiological remission. ANTIBIOTICS VERSUS PLACEBO FOR ACUTE BACTERIAL CONJUNCTIVITIS: Acute bacterial conjunctivitis is an infective condition in which the eyes become red and inflamed. The condition is not normally serious and usually recedes spontaneously within about a week. People with acute conjunctivitis are often given antibiotics, usually as eye drops or ointment, to speed recovery. The benefits of antibiotics to the sufferer of conjunctivitis have been questioned. The review of trials found that the signs of conjunctivitis went away more quickly in people taking antibiotics, but the benefits are marginal as in most cases the infection is self-limiting.] - Definitely not if they meet these criteria: Age 6 years or older, presentation in April through November, no or watery discharge, and no glued eye in the morning were the clinical factors found to be independently associated with a negative conjunctival culture. [Meltzer, J. A., S. Kunkov, et al. (2010). "Identifying children at low risk for bacterial conjunctivitis." Archives of pediatrics & adolescent medicine 164(3): 263-267. OBJECTIVE: To identify a population of children at low risk for bacterial conjunctivitis on the basis of history and physical examination findings. DESIGN: Prospective observational cohort study. SETTING: Urban pediatric emergency department. PARTICIPANTS: Children aged 6 months to 17 years with conjunctival erythema, eye discharge, or both. The exclusion criteria were eye trauma, exposure to a noxious chemical, contact lens use, and antibiotic drug use in the past 5 days. INTERVENTIONS: Clinicians completed a checklist of signs and symptoms and collected a conjunctival swab for bacterial culture. MAIN OUTCOME MEASURES: The chi(2) test, the Mann-Whitney test, and logistic regression were used to create a prediction model for a negative bacterial culture. RESULTS: Of 368 patients enrolled, 194 (52.7%) were males. The median patient age was 3 years (interquartile range, 1-5 years). Conjunctival cultures were negative in 130 patients (35.3%). Age 6 years or older, presentation in April through November, no or watery discharge, and no glued eye in the morning were the clinical factors found to be independently associated with a negative conjunctival culture. If 3 factors were present, 76.4% (95% confidence interval, 63.6%-85.6%) of patients had a negative culture. If all 4 factors were present, 92.3% (95% confidence interval, 66.1%-98.2%) of patients had a negative culture. CONCLUSION: The combination of 4 clinical factors may enable clinicians to identify children at low risk for bacterial conjunctivitis and may reduce routine antibiotic drug administration. Sheikh A, Hurwitz B. Topical antibiotics for acute bacterial conjunctivitis: a systematic review. Br J Gen Pract. 2001 Jun;51(467):473-7. ú Most rapid healing, least toxic: cefazolin sodium, Neosporinr ú Slowest healing: tobramycin, gentamicin ú Worst cornea effect: tobramycin, gentamicin ú No significant difference between control solution and any active drop Stern GA, Schemmer GB, Farber RD, Gorovoy MS. Effect of topical antibiotic solutions on corneal epithelial wound healing. Arch Ophthalmol. 1983 Apr;101(4):644-7. Dollery W. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Antibiotics and corneal abrasion. J Accid Emerg Med. 1998 Sep;15(5):352. ú Sulfacetamide ($8 / 15cc) = Sulamydr = Bleph-10r ($21) ú Trimethoprim/polymyxin B ($14 / 10cc) = Polytrimr ($34 / 10cc) ú Tobramycin ($8) = Tobrexr ($35) ú Gentamicin ($10) = Garamycinr ($25) ú Norfloxacin = Chibroxin ($25) ú Ciprofloxacin = Ciloxanr ($41)= $8.20 per cc = $246 / oz = $1968 / coffee cup = $8200 / liter All costs are for 5 cc bottle unless otherwise stated --Joe Lex