Rose PW et al. Chloramphenicol treatment for acute infective conjunctivitis in children in primary care: A randomised double-blind placebo-controlled trial.

Lancet 2005 Jul 2; 366:37-43. 

Antibiotics Not Needed for Acute Conjunctivitis

A pathogen was identified in about 80% of children; 67% tested positive for at least one bacterial pathogen (60% for Haemophilus influenzae, 20% forStreptococcus pneumoniae, and 10% for Moraxella catarrhalis). The type and prevalence of bacteria and viruses were similar in the two treatment groups.

On days 2 through 7, the mean time to cure was significantly shorter (about 0.3 days) in the antibiotic group than in the placebo group. On day 7, however, clinical cure rates did not differ significantly between the antibiotic and placebo groups (86% vs. 83%). Bacterial eradication was significantly better in the antibiotic group (40% vs. 26%). Complication rates were the same in the two groups, although one child had an apparent allergic reaction to chloramphenicol.

Comment: These results demonstrate that chloramphenicol eyedrops are no better than placebo drops for curing acute infective conjunctivitis. Interestingly, bacterial eradication was not necessary for clinical cure. We don't know whether these data apply to the more commonly prescribed ophthalmologic antibiotics. Home treatment without antibiotics for uncomplicated conjunctivitis, if possible, could significantly reduce healthcare costs. However, the study did not address whether antibiotics reduce the communicability of conjunctivitis.

— F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine August 29, 2005

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