A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice.
OBJECTIVE
To assess different management strategies for acute infective conjunctivitis.


METHODS
Open, factorial, randomised controlled trial.


METHODS
30 general practices in southern England.


METHODS
307 adults and children with acute infective conjunctivitis.


METHODS
One of three antibiotic prescribing strategies-immediate antibiotics (chloramphenicol eye drops; n = 104), no antibiotics (controls; n = 94), or delayed antibiotics (n = 109); a patient information leaflet or not; and an eye swab or not.


METHODS
Severity of symptoms on days 1-3 after consultation, duration of symptoms, and belief in the effectiveness of antibiotics for eye infections.


RESULTS
Prescribing strategies did not affect the severity of symptoms but duration of moderate symptoms was less with antibiotics: no antibiotics (controls) 4.8 days, immediate antibiotics 3.3 days (risk ratio 0.7, 95% confidence interval 0.6 to 0.8), delayed antibiotics 3.9 days (0.8, 0.7 to 0.9). Compared with no initial offer of antibiotics, antibiotic use was higher in the immediate antibiotic group: controls 30%, immediate antibiotics 99% (odds ratio 185.4, 23.9 to 1439.2), delayed antibiotics 53% (2.9, 1.4 to 5.7), as was belief in the effectiveness of antibiotics: controls 47%, immediate antibiotics 67% (odds ratio 2.4, 1.1 to 5.0), delayed antibiotics 55% (1.4, 0.7 to 3.0), and intention to reattend for eye infections: controls 40%, immediate antibiotics 68% (3.2, 1.6 to 6.4), delayed antibiotics 41% (1.0, 0.5 to 2.0). A patient information leaflet or eye swab had no effect on the main outcomes. Reattendance within two weeks was less in the delayed compared with immediate antibiotic group: 0.3 (0.1 to 1.0) v 0.7 (0.3 to 1.6).


CONCLUSIONS
Delayed prescribing of antibiotics is probably the most appropriate strategy for managing acute conjunctivitis in primary care. It reduces antibiotic use, shows no evidence of medicalisation, provides similar duration and severity of symptoms to immediate prescribing, and reduces reattendance for eye infections.


BACKGROUND
Current Controlled Trials ISRCTN32956955 [controlled-trials.com].
Everitt
Hazel A
HA
Primary Medical Care, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST. hae1@soton.ac.uk
Little
Paul S
PS
Smith
Peter W F
PW
D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D002701:Chloramphenicol / Q000627:therapeutic use*; D003234:Conjunctivitis, Bacterial / Q000188:drug therapy*; D005194:Family Practice; D006801:Humans; D007223:Infant; D009883:Ophthalmic Solutions / Q000627:therapeutic use; D010174:Pamphlets; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'; D012008:Recurrence; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D009883:Ophthalmic Solutions; D002701:Chloramphenicol