Antibiotics Versus Placebo for Acute Bacterial Conjunctivitis: Findings From a Cochrane Systematic Review

Su-Hsun Liu; Yu-Yen Chen; Ulugbek Nurmatov; Onno C P van Schayck; Irene C Kuo

doi:10.1016/j.ajo.2023.06.027

Antibiotics Versus Placebo for Acute Bacterial Conjunctivitis: Findings From a Cochrane Systematic Review

Am J Ophthalmol. 2024 Jan:257:143-153. doi: 10.1016/j.ajo.2023.06.027. Epub 2023 Jul 21.

Authors

Su-Hsun Liu¹, Yu-Yen Chen², Ulugbek Nurmatov³, Onno C P van Schayck⁴, Irene C Kuo⁵

Affiliations

¹ From the Department of Ophthalmology, School of Medicine (S.-H.L.); Department of Epidemiology, School of Public Health (S.-H.L.), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
² Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan (Y.-Y.C.); Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA (Y.-Y.C., I.C.K.); School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (Y.-Y.C.).
³ Division of Population Medicine, School of Medicine, the National Centre for Population Health and Wellbeing Research, Cardiff University, Cardiff, UK (U.N.).
⁴ Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, the Netherlands (O.C.P.V.S).
⁵ Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA (Y.-Y.C., I.C.K.). Electronic address: ickuo@jhmi.edu.

PMID: 37482371
PMCID: PMC10799969 (available on 2025-01-01)
DOI: 10.1016/j.ajo.2023.06.027

Abstract

Purpose: To summarize key findings from a Cochrane review of the benefits and safety of antibiotic therapy compared with placebo (or vehicle) for acute bacterial conjunctivitis.

Design: Systematic review and meta-analysis.

Methods: We included placebo-controlled randomized controlled trials (RCTs) that compared topical antibiotics with placebo. We followed Cochrane methods for trial selection, data extraction, risk of bias assessment, and evidence synthesis.

Results: Twenty-one RCTs involving 8805 participants with acute bacterial conjunctivitis were included. Fifteen (71%) RCTs examined fluoroquinolone (FQ) drops, 3 tested macrolides, alone or in combination with steroids, and another 3 compared other non-FQ antibiotics. Intention-to-treat estimates suggested that compared with placebo, antibiotics may increase clinical recovery by 26% (risk ratio [RR]: 1.26; 95% confidence interval [CI]: 1.09-1.46) at the end of therapy (5 RCTs, 1474 participants). Modified intention-to-treat estimates, in which only participants with laboratory-confirmed bacterial conjunctivitis were analyzed, indicated that antibiotics were associated with 53% higher likelihood of microbiological cure as compared with placebo (RR: 1.53; 95% CI: 1.34-1.74; 10 RCTs, 2827 participants). Non-FQs (RR: 4.05; 95% CI: 1.36-12.00), but not FQs (RR: 0.70; 95% CI: 0.54-0.90), were likely to increase treatment-associated ocular complications such as eye pain, discomfort, and allergic reactions; the certainty of level of evidence was very low.

Conclusions: Moderate level certainty of evidence suggested that antibiotics may increase the likelihood of clinical recovery and microbiological clearance compared with placebo. Very low-level certainty of evidence suggested that antibiotics may be associated with potential harm in patients with acute bacterial conjunctivitis, but the potential risk of bias from study design, inconsistency in outcome measurement, and reporting limit the evidence to very low certainty.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Anti-Bacterial Agents* / therapeutic use
Conjunctivitis, Bacterial* / drug therapy
Humans

Substances

Anti-Bacterial Agents

Grants and funding

UG1 EY020522/EY/NEI NIH HHS/United States