Most healthy 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, and his associates. They suggested that parents cleanse their children's eyes with lubricating eyedrops instead of rushing them off 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 clinical diagnosis of conjunctivitis to either chloramphenicol eyedrops (0.5%) or placebo (distilled water containing 1.5% boric acid and 0.3% borax). Parents applied the 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% of those in the antibiotic group were clinically cured, compared with 83% of those in the placebo group. When 307 of the children were followed up at 6 weeks, fewer than 5% in each group 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 that 80% of the children had bacterial infections. Among 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, Dr. Rose and his associates said failure to achieve it 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.”