Most children with conjunctivitis will get better by themselves and don't need an ophthalmic antibiotic, Peter W. Rose, M.B., and his colleagues reported.
“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,” said Dr. Rose of Oxford (England) University. The researchers suggest that parents cleanse their children's eyes with eye drops instead of rushing to the pediatrician at the first sign of conjunctivitis (Lancet 2005;366:37–43).
The investigators randomized 326 children (mean age 3.3 years) with a diagnosis of conjunctivitis to chloramphenicol eye drops (0.5%) or placebo (distilled water containing 1.5% boric acid and 0.3% borax). Parents used drops every 2 hours for the first 24 hours when the child was awake and four times a day until 48 hours after symptoms resolved.
After 7 days, 86% in the antibiotic group were clinically cured, compared with 83% of the placebo group. When 307 of the children were followed up at 6 weeks, fewer than 5% had experienced a relapse or new infection.
Only one reaction—a case of swollen eyelids and face—was attributed to antibiotic treatment.
Baseline cultures showed 80% had bacterial infections. In this group, the clinical cure rate did not differ significantly between chloramphenicol and placebo (85% vs. 80%), but more of the chloramphenicol group than the placebo group experienced bacterial eradication (40% vs. 23%).
Although eradication is not necessary for a clinical cure, the researchers said failure to eradicate bacteria could impact transmission. “Despite our results, antibiotic treatment might still reduce the absolute number, and, hence, transmissibility of pathogens, and further research might be necessary if antibiotics cease to be prescribed for this disorder.”
The data appear to support prescription policy changes for uncomplicated conjunctivitis, but it still could be a tough sell for parents and schools, they admitted.
Here is a case of hemorrhagic conjunctivitis with subconjunctival hemorrhages and lid swelling. ©Mosby, Inc. 2004. Gershon: Krugman's Infectious Diseases of Children, 11E