Delayed antibiotic prescription may be best strategy for conjunctivitis

Delaying the prescription of topical antibiotics for 3 days may help to reduce unnecessary treatment of acute infective conjunctivitis without compromising efficacy, a study in England suggests.

Delayed prescribing — giving a prescription that can be picked up at parents' or patients' discretion 3 days after the initial office visit — reduced antibiotic use by 50% and provided a level of symptom relief similar to immediate prescribing, the study authors found.

"Our [previous] qualitative research indicated that patients' lack of awareness of the self-limiting nature of conjunctivitis was an important reason for attending for antibiotics. It also showed patients were happy with delayed prescribing and were comfortable about deciding whether to start antibiotics," said Hazel A. Everitt and colleagues in the study, published in the BMJ.

Ms. Everitt and colleagues randomly assigned 307 children and adults with infective conjunctivitis to three treatment groups; 104 patients received immediate treatment with chloramphenicol drops, 109 patients received a prescription for the drops that could be picked up after 3 days, and 94 patients received no antibiotics.

The researchers found that 99% of the immediate treatment group used the antibiotics, but only 53% of the delayed treatment group chose to use the drugs, according to the study.

Of the initially untreated patients, 30% ended up using antibiotics despite no initial offer, possibly due to a common misbelief that such antibiotics are necessary despite only mild symptoms, the authors noted.

Antibiotic use did not affect symptom severity, but it did lessen the duration of moderate symptoms: 4.8 days for control patients, 3.9 days for delayed treatment patients and 3.3 days for immediate treatment patients, according to the study.

Validation diaries completed by participants revealed that 68% of immediate treatment patients would likely again seek care for eye infections. In contrast, only 41% of delayed treatment patients and 40% of control patients indicated they would seek such care.

"Those in the delayed antibiotic group were less likely to reattend within 2 weeks than those in the control group, but no significant difference was found [in reattendance] between the immediate antibiotic group and the controls," the authors said.

"It might be worth prescribing antibiotics for the 1 to 2 days reduction in moderately bad symptoms ... however, is it worth prescribing immediate antibiotics to all when the benefit is likely to be a half day's worth reduction in moderate symptoms? It may well depend on individual patients' circumstances," the authors said.

The study is published in the August issue of the British Journal of Medicine.