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JAMA Oct 2013Conjunctivitis is a common problem. (Review)
Review
IMPORTANCE
Conjunctivitis is a common problem.
OBJECTIVE
To examine the diagnosis, management, and treatment of conjunctivitis, including various antibiotics and alternatives to antibiotic use in infectious conjunctivitis and use of antihistamines and mast cell stabilizers in allergic conjunctivitis.
EVIDENCE REVIEW
A search of the literature published through March 2013, using PubMed, the ISI Web of Knowledge database, and the Cochrane Library was performed. Eligible articles were selected after review of titles, abstracts, and references.
FINDINGS
Viral conjunctivitis is the most common overall cause of infectious conjunctivitis and usually does not require treatment; the signs and symptoms at presentation are variable. Bacterial conjunctivitis is the second most common cause of infectious conjunctivitis, with most uncomplicated cases resolving in 1 to 2 weeks. Mattering and adherence of the eyelids on waking, lack of itching, and absence of a history of conjunctivitis are the strongest factors associated with bacterial conjunctivitis. Topical antibiotics decrease the duration of bacterial conjunctivitis and allow earlier return to school or work. Conjunctivitis secondary to sexually transmitted diseases such as chlamydia and gonorrhea requires systemic treatment in addition to topical antibiotic therapy. Allergic conjunctivitis is encountered in up to 40% of the population, but only a small proportion of these individuals seek medical help; itching is the most consistent sign in allergic conjunctivitis, and treatment consists of topical antihistamines and mast cell inhibitors.
CONCLUSIONS AND RELEVANCE
The majority of cases in bacterial conjunctivitis are self-limiting and no treatment is necessary in uncomplicated cases. However, conjunctivitis caused by gonorrhea or chlamydia and conjunctivitis in contact lens wearers should be treated with antibiotics. Treatment for viral conjunctivitis is supportive. Treatment with antihistamines and mast cell stabilizers alleviates the symptoms of allergic conjunctivitis.
Topics: Anti-Bacterial Agents; Conjunctivitis, Bacterial; Conjunctivitis, Viral; Humans; Sexually Transmitted Diseases
PubMed: 24150468
DOI: 10.1001/jama.2013.280318 -
Bacterial Conjunctivitis in Childhood: Etiology, Clinical Manifestations, Diagnosis, and Management.Recent Patents on Inflammation &... 2018Bacterial conjunctivitis is a common reason for children to be seen in pediatric practices. A correct diagnosis is important so that appropriate treatment can be...
BACKGROUND
Bacterial conjunctivitis is a common reason for children to be seen in pediatric practices. A correct diagnosis is important so that appropriate treatment can be instituted.
OBJECTIVE
To provide an update on the evaluation, diagnosis, and treatment of bacterial conjunctivitis in children.
METHODS
A PubMed search was completed in Clinical Queries using the key term "bacterial conjunctivitis". Patents were searched using the key term "bacterial conjunctivitis" from www.freepatentsonline.com and www.google.com/patents.
RESULTS
In the neonatal period, bacterial conjunctivitis is rare and the most common cause of organism is Staphylococcus aureus, followed by Chlamydia trachomatis. In infants and older children, bacterial conjunctivitis is most often caused by Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Clinically, bacterial conjunctivitis is characterized by a purulent eye discharge, or sticky eyes on awakening, a foreign body sensation and conjunctival injection (pink eye). The diagnosis is made clinically. Cultures are unnecessary. Some authors suggest a watchful observation approach as most cases of bacterial conjunctivitis are self-limited. A Cochrane review suggests the use of antibiotic eye drops is associated with modestly improved rates of clinical and microbiological remission as compared to the use of placebo. Various investigators have also disclosed patents for the treatment of conjunctivitis.
CONCLUSION
The present consensus supports the use of topical antibiotics for bacterial conjunctivitis. Topical antibiotics shorten the course of the disease, reduce discomfort, prevent person-to-person transmission and reduce the rate of reinfection.
Topics: Anti-Bacterial Agents; Child; Chlamydia trachomatis; Conjunctivitis, Bacterial; Haemophilus influenzae; Humans; Infant; Ophthalmic Solutions; Patents as Topic; Staphylococcus aureus
PubMed: 29380707
DOI: 10.2174/1872213X12666180129165718 -
The Cochrane Database of Systematic... Mar 2023Acute bacterial conjunctivitis is an infection of the conjunctiva and is one of the most common ocular disorders in primary care. Antibiotics are generally prescribed on... (Review)
Review
BACKGROUND
Acute bacterial conjunctivitis is an infection of the conjunctiva and is one of the most common ocular disorders in primary care. Antibiotics are generally prescribed on the basis that they may speed recovery, reduce persistence, and prevent keratitis. However, many cases of acute bacterial conjunctivitis are self-limited, resolving without antibiotic therapy. This Cochrane Review was first published in The Cochrane Library in 1999, then updated in 2006, 2012, and 2022.
OBJECTIVES
To assess the benefits and side effects of antibiotic therapy in the management of acute bacterial conjunctivitis.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2022, Issue 5), MEDLINE (January 1950 to May 2022), Embase (January 1980 to May 2022), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.
CLINICALTRIALS
gov), and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases in May 2022. SELECTION CRITERIA: We included randomized controlled trials (RCTs) in which any form of antibiotic treatment, with or without steroid, had been compared with placebo/vehicle in the management of acute bacterial conjunctivitis. This included topical and systemic antibiotic treatments.
DATA COLLECTION AND ANALYSIS
Two authors independently reviewed the titles and abstracts of identified studies. We assessed the full text of all potentially relevant studies and determined the included RCTs, which were further assessed for risk of bias using Cochrane methodology. We performed data extraction in a standardized manner and conducted random-effects meta-analyses using RevMan Web.
MAIN RESULTS
We included 21 eligible RCTs, 10 of which were newly identified in this update. A total of 8805 participants were randomized. All treatments were topical in the form of drops or ointment. The trials were heterogeneous in terms of their eligibility criteria, the nature of the intervention (antibiotic drug class, which included fluoroquinolones [FQs] and non-FQs; dosage frequency; duration of treatment), the outcomes assessed and the time points of assessment. We judged one trial to be of high risk of bias, four as low risk of bias, and the others as raising some concerns. Based on intention-to-treat (ITT) population, antibiotics likely improved clinical cure (resolution of clinical symptoms or signs) by 26% (RR 1.26, 95% CI 1.09 to 1.46; 5 trials, 1474 participants; moderate certainty) as compared with placebo. Subgroup analysis showed no differences by antibiotic class (P = 0.67) or treatment duration (P = 0.60). In the placebo group, 55.5% (408/735) of participants had spontaneous clinical resolution by days 4 to 9 versus 68.2% (504/739) of participants treated with an antibiotic. Based on modified ITT population, in which participants were analyzed after randomization on the basis of positive microbiological culture, antibiotics likely increased microbiological cure (RR 1.53, 95% CI 1.34 to 1.74; 10 trials, 2827 participants) compared with placebo at the end of therapy; there were no subgroup differences by drug class (P = 0.60). No study evaluated the cost-effectiveness of antibiotic treatment. Patients receiving antibiotics had a lower risk of treatment incompletion than those in the placebo group (RR 0.64, 95% CI 0.52 to 0.78; 13 trials, 5573 participants; moderate certainty) and were 27% less likely to have persistent clinical infection (RR 0.73, 95% CI 0.65 to 0.81; 19 trials, 5280 participants; moderate certainty). There was no evidence of serious systemic side effects reported in either the antibiotic or placebo group (very low certainty). When compared with placebo, FQs (RR 0.70, 95% CI 0.54 to 0.90) but not non-FQs (RR 4.05, 95% CI 1.36 to 12.00) may result in fewer participants with ocular side effects. However, the estimated effects were of very low certainty.
AUTHORS' CONCLUSIONS
The findings of this update suggest that the use of topical antibiotics is associated with a modestly improved chance of resolution in comparison to the use of placebo. Since no evidence of serious side effects was reported, use of antibiotics may therefore be considered to achieve better clinical and microbiologic efficacy than placebo. Increasing the proportion of participants with clinical cure or increasing the speed of recovery or both are important for individual return to work or school, allowing people to regain quality of life. Future studies may examine antiseptic treatments with topical antibiotics for reasons of cost and growing antibiotic resistance.
Topics: Humans; Anti-Bacterial Agents; Conjunctivitis, Bacterial; Randomized Controlled Trials as Topic
PubMed: 36912752
DOI: 10.1002/14651858.CD001211.pub4 -
Clinical Evidence Dec 2004
Review
Topics: Adult; Anti-Bacterial Agents; Child; Conjunctivitis, Bacterial; Humans
PubMed: 15865690
DOI: No ID Found -
Acta Ophthalmologica Feb 2008Acute bacterial conjunctivitis is the eye disease most commonly seen by general practitioners, and is estimated to represent approximately 1% of all consultations in... (Review)
Review
Acute bacterial conjunctivitis is the eye disease most commonly seen by general practitioners, and is estimated to represent approximately 1% of all consultations in primary care. This article gives a review of the epidemiology, aetiology, clinical picture, complications, differential diagnoses, in vitro examinations and therapy of acute bacterial conjunctivitis. Until now, topical antibacterial therapy has generally been preferred by both physicians and patients because this will usually shorten the course of the disease slightly and allow the early readmittance of children to their kindergarten or school. Recently, several reports from primary care have confirmed the well-known clinical experience that the disorder has an excellent prognosis with a high frequency of spontaneous remission. In accordance, an expectant attitude or delayed prescription policy are now frequently strongly recommended. However, these reports also emphasize the difficulty in making a correct clinical distinction between bacterial and viral conjunctivitis. The effect of a general non-prescription attitude on transmission rates of pathogens also remains to be clarified. This must be born in mind when deciding how these patients should be handled. The socioeconomic and medical pros and cons of different treatment policies are discussed, and a highly personal view on the optimal handling strategy for these patients is also presented.
Topics: Acute Disease; Administration, Topical; Anti-Bacterial Agents; Conjunctivitis, Bacterial; Diagnosis, Differential; Humans; Randomized Controlled Trials as Topic
PubMed: 17970823
DOI: 10.1111/j.1600-0420.2007.01006.x -
Cornea Apr 2017To investigate the microbial cause and antibiotic susceptibility of neonatal bacterial conjunctivitis in Korean patients in the 21st century. (Review)
Review
PURPOSE
To investigate the microbial cause and antibiotic susceptibility of neonatal bacterial conjunctivitis in Korean patients in the 21st century.
METHODS
We retrospectively reviewed the medical records of patients diagnosed with neonatal bacterial conjunctivitis between January 2000 and December 2015. We recorded the organism, antibiotic susceptibility, and antibiotics used.
RESULTS
A total of 82 neonates were included in the study (53 males and 29 females), with a mean age of 17.5 ± 7.1 days. The most commonly isolated organisms were Staphylococcus aureus (43 cases, 52.4%), coagulase-negative staphylococci (11 cases, 13.4%), Staphylococcus epidermidis (11 cases, 13.4%), Serratia marcescens (4 cases, 4.9%), Pseudomonas aeruginosa (4 cases, 4.9%), and Enterobacter cloacae (3 cases, 3.7%). We found no cases of Neisseria gonorrhoeae or Chlamydia trachomatis infection. Resistance to methicillin (83.7%), macrolide (81.4%), and aminoglycoside (23.3%) was observed in patients with S. aureus infection. Conjunctivitis that did not improve with erythromycin or tobramycin generally improved with the additional use of tosufloxacin.
CONCLUSIONS
The prevalence of neonatal gonococcal or chlamydial conjunctivitis has decreased in the 21st century. However, methicillin-resistant S. aureus has been increasing, but these cases are responsive to tosufloxacin.
Topics: Anti-Bacterial Agents; Bacteria; Coinfection; Conjunctivitis, Bacterial; Eye Infections, Bacterial; Female; Humans; Infant, Newborn; Male; Microbial Sensitivity Tests; Prevalence; Republic of Korea; Retrospective Studies
PubMed: 28002109
DOI: 10.1097/ICO.0000000000001122 -
Clinical Evidence Dec 2005
Review
Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Child; Conjunctivitis, Bacterial; Humans
PubMed: 16620434
DOI: No ID Found -
Clinical Evidence Jun 2003
Review
Topics: Adult; Anti-Infective Agents; Child; Conjunctivitis, Bacterial; Humans
PubMed: 15366164
DOI: No ID Found -
Clinical Evidence Jun 2002
Comparative Study Review
Topics: Administration, Oral; Administration, Topical; Adult; Anti-Bacterial Agents; Child; Conjunctivitis, Bacterial; Humans; Microbial Sensitivity Tests; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 12230683
DOI: No ID Found -
Cleveland Clinic Journal of Medicine Jul 2008Bacterial conjunctivitis is common and occurs in patients of all ages. Typical signs are a red eye and purulent drainage that persists throughout the day. Gonococcal and... (Review)
Review
Bacterial conjunctivitis is common and occurs in patients of all ages. Typical signs are a red eye and purulent drainage that persists throughout the day. Gonococcal and chlamydial conjunctivitis must be treated with systemic antibiotics. Bacterial conjunctivitis due to most other organisms can be treated empirically with topical antibiotics. Red flags suggesting a complicated case requiring referral to an ophthalmologist include reduced vision, severe eye pain, a hazy-appearing cornea, contact lens use, and poor response to empirical treatment.
Topics: Administration, Topical; Conjunctivitis, Bacterial; Diagnosis, Differential; Humans; Internal Medicine
PubMed: 18646586
DOI: 10.3949/ccjm.75.7.507