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 straightforward 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 randomised 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.
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Contact: Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
21-Jun-2005