Acute infective conjunctivitis in primary care: Who needs antibiotics? An individual patient data meta-analysis

Joanna Jefferis, Rafael Perera, Hazel Everitt, Henk Van Weert, Remco Rietveld, Paul Glasziou, Peter Rose

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Abstract

Background: Acute infective conjunctivitis is a common problem in primary care, traditionally managed with topical antibiotics. A number of clinical trials have questioned the benefit of topical antibiotics for patients with acute infective conjunctivitis. Aim: To determine the benefit of antibiotics for the treatment of acute infective conjunctivitis in primary care and which subgroups benefit most. Design: An individual patient datameta-analysis. Method: Relevant trials were identified and individual patient data gathered for meta-analysis and subgroup analysis. Results: Three eligible trials were identified. Individual patient data were available from all primary care trials and data were available for analysis in 622 patients. Eighty per cent (246/308) of patients who received antibiotics and 74% (233/314) of controls were cured at day 7. There was a significant benefit of antibiotics versus control for cure at seven days in all cases combined (risk difference 0.08, 95% confidence interval (CI) = 0.01 to 0.14). Subgroups that showed a significant benefit from antibiotics were patients with purulent discharge (risk difference 0.09, 95% CI = 0.01 to 0.17) and patients with mild severity of red eye (risk difference 0.10, 95% CI = 0.02 to 0.18), while the type of control used (placebo drops versus nothing) showed a statistically significant interaction (P = 0.03). Conclusion: Acute conjunctivitis seen in primary care can be thought of as a self-limiting condition, with most patients getting better regardless of antibiotic therapy. Patients with purulent discharge or a mild severity of red eye may have a small benefit from antibiotics. Prescribing practices need to be updated, taking into account these results.

Original languageEnglish
JournalBritish Journal of General Practice
Volume61
Issue number590
DOIs
Publication statusPublished - 2011

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Conjunctivitis
Meta-Analysis
Primary Health Care
Anti-Bacterial Agents
Confidence Intervals
Placebos
Clinical Trials

Cite this

Jefferis, Joanna ; Perera, Rafael ; Everitt, Hazel ; Van Weert, Henk ; Rietveld, Remco ; Glasziou, Paul ; Rose, Peter. / Acute infective conjunctivitis in primary care : Who needs antibiotics? An individual patient data meta-analysis. In: British Journal of General Practice. 2011 ; Vol. 61, No. 590.
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abstract = "Background: Acute infective conjunctivitis is a common problem in primary care, traditionally managed with topical antibiotics. A number of clinical trials have questioned the benefit of topical antibiotics for patients with acute infective conjunctivitis. Aim: To determine the benefit of antibiotics for the treatment of acute infective conjunctivitis in primary care and which subgroups benefit most. Design: An individual patient datameta-analysis. Method: Relevant trials were identified and individual patient data gathered for meta-analysis and subgroup analysis. Results: Three eligible trials were identified. Individual patient data were available from all primary care trials and data were available for analysis in 622 patients. Eighty per cent (246/308) of patients who received antibiotics and 74{\%} (233/314) of controls were cured at day 7. There was a significant benefit of antibiotics versus control for cure at seven days in all cases combined (risk difference 0.08, 95{\%} confidence interval (CI) = 0.01 to 0.14). Subgroups that showed a significant benefit from antibiotics were patients with purulent discharge (risk difference 0.09, 95{\%} CI = 0.01 to 0.17) and patients with mild severity of red eye (risk difference 0.10, 95{\%} CI = 0.02 to 0.18), while the type of control used (placebo drops versus nothing) showed a statistically significant interaction (P = 0.03). Conclusion: Acute conjunctivitis seen in primary care can be thought of as a self-limiting condition, with most patients getting better regardless of antibiotic therapy. Patients with purulent discharge or a mild severity of red eye may have a small benefit from antibiotics. Prescribing practices need to be updated, taking into account these results.",
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Acute infective conjunctivitis in primary care : Who needs antibiotics? An individual patient data meta-analysis. / Jefferis, Joanna; Perera, Rafael; Everitt, Hazel; Van Weert, Henk; Rietveld, Remco; Glasziou, Paul; Rose, Peter.

In: British Journal of General Practice, Vol. 61, No. 590, 2011.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Acute infective conjunctivitis in primary care

T2 - Who needs antibiotics? An individual patient data meta-analysis

AU - Jefferis, Joanna

AU - Perera, Rafael

AU - Everitt, Hazel

AU - Van Weert, Henk

AU - Rietveld, Remco

AU - Glasziou, Paul

AU - Rose, Peter

PY - 2011

Y1 - 2011

N2 - Background: Acute infective conjunctivitis is a common problem in primary care, traditionally managed with topical antibiotics. A number of clinical trials have questioned the benefit of topical antibiotics for patients with acute infective conjunctivitis. Aim: To determine the benefit of antibiotics for the treatment of acute infective conjunctivitis in primary care and which subgroups benefit most. Design: An individual patient datameta-analysis. Method: Relevant trials were identified and individual patient data gathered for meta-analysis and subgroup analysis. Results: Three eligible trials were identified. Individual patient data were available from all primary care trials and data were available for analysis in 622 patients. Eighty per cent (246/308) of patients who received antibiotics and 74% (233/314) of controls were cured at day 7. There was a significant benefit of antibiotics versus control for cure at seven days in all cases combined (risk difference 0.08, 95% confidence interval (CI) = 0.01 to 0.14). Subgroups that showed a significant benefit from antibiotics were patients with purulent discharge (risk difference 0.09, 95% CI = 0.01 to 0.17) and patients with mild severity of red eye (risk difference 0.10, 95% CI = 0.02 to 0.18), while the type of control used (placebo drops versus nothing) showed a statistically significant interaction (P = 0.03). Conclusion: Acute conjunctivitis seen in primary care can be thought of as a self-limiting condition, with most patients getting better regardless of antibiotic therapy. Patients with purulent discharge or a mild severity of red eye may have a small benefit from antibiotics. Prescribing practices need to be updated, taking into account these results.

AB - Background: Acute infective conjunctivitis is a common problem in primary care, traditionally managed with topical antibiotics. A number of clinical trials have questioned the benefit of topical antibiotics for patients with acute infective conjunctivitis. Aim: To determine the benefit of antibiotics for the treatment of acute infective conjunctivitis in primary care and which subgroups benefit most. Design: An individual patient datameta-analysis. Method: Relevant trials were identified and individual patient data gathered for meta-analysis and subgroup analysis. Results: Three eligible trials were identified. Individual patient data were available from all primary care trials and data were available for analysis in 622 patients. Eighty per cent (246/308) of patients who received antibiotics and 74% (233/314) of controls were cured at day 7. There was a significant benefit of antibiotics versus control for cure at seven days in all cases combined (risk difference 0.08, 95% confidence interval (CI) = 0.01 to 0.14). Subgroups that showed a significant benefit from antibiotics were patients with purulent discharge (risk difference 0.09, 95% CI = 0.01 to 0.17) and patients with mild severity of red eye (risk difference 0.10, 95% CI = 0.02 to 0.18), while the type of control used (placebo drops versus nothing) showed a statistically significant interaction (P = 0.03). Conclusion: Acute conjunctivitis seen in primary care can be thought of as a self-limiting condition, with most patients getting better regardless of antibiotic therapy. Patients with purulent discharge or a mild severity of red eye may have a small benefit from antibiotics. Prescribing practices need to be updated, taking into account these results.

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DO - 10.3399/bjgp11X593811

M3 - Article

VL - 61

JO - Journal of the Royal College of General Practitioners

JF - Journal of the Royal College of General Practitioners

SN - 0960-1643

IS - 590

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