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Topical antibiotics for conjunctivitis?

Topical antibiotics for conjunctivitis?. Infective conjunctivitis. It is a common condition in the community The differential diagnosis is very important How do we manage conjunctivitis? Ought we to prescribe antibiotics:– routinely using a delayed prescription not at all or selectively?.

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Topical antibiotics for conjunctivitis?

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  1. Topical antibiotics for conjunctivitis?

  2. Infective conjunctivitis • It is a common condition in the community • The differential diagnosis is very important • How do we manage conjunctivitis? • Ought we to prescribe antibiotics:– • routinely • using a delayed prescription • not at all • or selectively?

  3. Background informationClinical Knowledge Summaries (formerly PRODIGY) • 2–5% of GP consultations concern the eye; infective conjunctivitis accounts for around 35% of these. • 1 in 8 children get conjunctivitis each year. (Rose, Lancet 2005) • 3 million prescriptions for topical eye antibiotics are supplied each year. (PPD) • BUT – around 50% of cases of acute conjunctivitis are bacterial and 50% are viral.

  4. Red flags for conjunctivitis- acute glaucoma, keratitis and uveitisClinical Knowledge Summaries • Moderate to severe eye pain • if there is moderate to severe pain, a secondary cause for the conjunctivitis must be excluded. • Marked redness of the eye • the greater the redness, the more likely it is that there is a serious secondary cause • ciliary injection, which is not always obvious, occurs with inflammation of deeper structures due to a secondary cause. It is indicated by redness and dilated blood vessels seen between the white of the eye and the coloured part of the eye. • Reduced visual acuity • any loss of visual acuity, measured with a Snellen chart, may indicate a serious secondary cause of conjunctivitis.

  5. Evidence for topical antibiotics • Most people (65%) receiving placebo experienced clinical remission after 2–5 days. Cochrane • 326 children aged 6 months to 12 years 12 general medical practices in the UK Chloramphenicol eye drops vs. placebo Rose PW, et al. Lancet 2005; 366: 37–43 • Clinical cure at day 7, occurred in 83% of children with placebo compared with 86% of children with chloramphenicol (not statistically significant)

  6. What do patients think?Everitt, Kumar & Little. BJGP 2003; 53: 36–41 • Patients • attended as they were not aware of the self-limiting nature of the condition • When they did know • theypreferred not to receive medication • and were open to alternative management approaches.

  7. So what should we do?Clinical Knowledge Summaries • Different approaches to treatment have been suggested: • treating all cases • offering a delayed prescribing strategy • or selectively treating cases that are most likely to have a bacterial cause. • The most suitable method depends on individual clinical circumstances and should be done with the knowledge and consent of the patient (i.e. shared decision making). • Ideas, concerns, expectations • Options, implications, choice, justification

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