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'Pinkeye' Treatment May Be More About Speed Than Need

Armen Hareyan's picture


Antibiotics accelerate recovery from acute bacterial conjunctivitis, but that is all they do clinically as the condition is self-resolving with time, researchers conclude in a new review of studies.

"We now have strong and conclusive evidence, both from primary and secondary care, and in children and adults that antibiotics are of only limited value in improving outcomes from acute bacterial conjunctivitis," said lead author Aziz Sheikh, M.D., of the University of Edinburgh in Scotland. "The vast majority of people will spontaneously improve within a few days of the onset of the condition."

However, a U.S. expert not involved with the review doubts the findings will change prescribing practices, because people won't be willing to wait for the discomfort, nuisance and unpleasant cosmetic effects of 'pinkeye' to pass.

"Bacterial conjunctivitis is primarily a pediatric disease and is typically uncomfortable for patients," said Michael Nordlund, an ophthalmic surgeon at the Cincinnati Eye Clinic. "These kids can be very light-sensitive, irritable from eye pain and cosmetically they can look horrible with green or yellow purulent discharge draining down their cheeks."

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

This review appears in the wake of a growing concern about the use of antibiotics for the treatment of self-resolving medical conditions, and an increasing fear that antibiotic resistance due to overuse could become a major public health problem.

Acute bacterial conjunctivitis is an infection which causes the eyes to become inflamed and red. Acute viral conjunctivitis, which has the same symptoms and is not responsive to antibiotics, is also self-resolving. When symptoms appear, physicians usually prescribe a topical antibiotic in an eye drops or an ointment.

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Sheikh's team gathered results from five clinical trials involving 1034 subjects, adults and children, who had been diagnosed with acute bacterial conjunctivitis and treated with either an antibiotic or placebo.

They found that for 65 percent of the placebo patients the condition resolved itself in two to five days. But they also reported that topical antibiotic treatment significantly improved time to resolution for those treated in the early phase of the disease.

They studies showed no serious side effects in either the treated groups or placebo groups.

Nordlund said that the review confirms "two generally accepted assumptions regarding bacterial conjunctivitis: that topical antibiotics are an indicated and effective treatment for bacterial conjunctivitis and that bacterial conjunctivitis is generally a self-limited disease."

However, added Nordlund, "Clinically, I do not believe the study will change prescribing habits... It can be difficult for many physicians to distinguish the two entities clinically and laboratory analysis is expensive, a nuisance to perform and it takes one to three days to get results back. Most bacterial conjunctivitis can be eradicated in this time period with treatment."

Regarding the finding that 65 percent of conjunctivitis resolved spontaneously in a few days, Nordlund said, "That means 35 percent of patients did not resolve and, therefore, should a physician choose not to treat patients with bacterial conjunctivitis, over one-third of patients will likely be calling back or returning to the office over this time period... Few physicians have time or energy for these office returns."

Another practical concern is that "pediatric patients with conjunctivitis are typically restricted from daycare and school until they have been on treatment for 24 hours. Thus, parents of these patients appropriately expect some form of treatment," Nordlund said.

The review authors say that none of the studies included in the review attempted to evaluate the cost-effectiveness of topical antibiotic treatment versus self-resolution. Nordlund agreed that "a definitive future study should look at the costs of treatment" but said it would be difficult to take into account "a variety of quality-of-life issues and the lost wages or incurred babysitting costs for those patients that are not treated and therefore restricted from daycare or school."