Unstable angina

1
Topical antibiotics for conjunctivitis?
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Infective conjunctivitis

• It is a common condition in the community
• The differential diagnosis is very important
• How do we manage conjunctivitis?
• Ought we to prescribe antibiotics
• routinely
• using a delayed prescription
• not at all
• or selectively?

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Background informationClinical Knowledge
Summaries (formerly PRODIGY)

• 25 of GP consultations concern the eye
  infective conjunctivitis accounts for around 35
  of these.
• 1 in 8 children get conjunctivitis each year.
  (Rose, Lancet 2005)
• 3 million prescriptions for topical eye
  antibiotics are supplied each year. (PPD)
• BUT around 50 of cases of acute
  conjunctivitis are bacterial and 50 are viral.

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Red flags for conjunctivitis- acute glaucoma,
keratitis and uveitisClinical Knowledge Summaries

• Moderate to severe eye pain
• if there is moderate to severe pain, a secondary
  cause for the conjunctivitis must be excluded.
• Marked redness of the eye
• the greater the redness, the more likely it is
  that there is a serious secondary cause
• ciliary injection, which is not always obvious,
  occurs with inflammation of deeper structures due
  to a secondary cause. It is indicated by redness
  and dilated blood vessels seen between the white
  of the eye and the coloured part of the eye.
• Reduced visual acuity
• any loss of visual acuity, measured with a
  Snellen chart, may indicate a serious secondary
  cause of conjunctivitis.

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Evidence for topical antibiotics

• Most people (65) receiving placebo experienced
  clinical remission after 25 days. Cochrane
• 326 children aged 6 months to 12 years
• 12 general medical practices in the UK
• Chloramphenicol eye drops vs. placebo
• Rose PW, et al. Lancet 2005 366 3743
• Clinical cure at day 7, occurred in 83 of
  children with placebo compared with 86 of
  children with chloramphenicol (not statistically
  significant)

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What do patients think?Everitt, Kumar Little.
BJGP 2003 53 3641

• Patients
• attended as they were not aware of the
  self-limiting nature of the condition
• When they did know
• they preferred not to receive medication
• and were open to alternative management
  approaches.

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So what should we do?Clinical Knowledge Summaries

• Different approaches to treatment have been
  suggested
• treating all cases
• offering a delayed prescribing strategy
• or selectively treating cases that are most
  likely to have a bacterial cause.
• The most suitable method depends on individual
  clinical circumstances and should be done with
  the knowledge and consent of the patient (i.e.
  shared decision making).
• Ideas, concerns, expectations
• Options, implications, choice, justification