BACKGROUND: Acute bacterial conjunctivitis is an infection of the conjunctiva and is one of the most common ocular disorders in primary care. Antibiotics are generally prescribed on the basis that they may speed recovery, reduce persistence, and prevent keratitis. However, many cases of acute bacterial conjunctivitis are self-limited, resolving without antibiotic therapy. This Cochrane Review was first published in The Cochrane Library in 1999, then updated in 2006, 2012, and 2022.
OBJECTIVES: To assess the benefits and side effects of antibiotic therapy in the management of acute bacterial conjunctivitis.
SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2022, Issue 5), MEDLINE (January 1950 to May 2022), Embase (January 1980 to May 2022), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.
CLINICALTRIALS: gov), and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases in May 2022. SELECTION CRITERIA: We included randomized controlled trials (RCTs) in which any form of antibiotic treatment, with or without steroid, had been compared with placebo/vehicle in the management of acute bacterial conjunctivitis. This included topical and systemic antibiotic treatments.
DATA COLLECTION AND ANALYSIS: Two authors independently reviewed the titles and abstracts of identified studies. We assessed the full text of all potentially relevant studies and determined the included RCTs, which were further assessed for risk of bias using Cochrane methodology. We performed data extraction in a standardized manner and conducted random-effects meta-analyses using RevMan Web.
MAIN RESULTS: We included 21 eligible RCTs, 10 of which were newly identified in this update. A total of 8805 participants were randomized. All treatments were topical in the form of drops or ointment. The trials were heterogeneous in terms of their eligibility criteria, the nature of the intervention (antibiotic drug class, which included fluoroquinolones [FQs] and non-FQs; dosage frequency; duration of treatment), the outcomes assessed and the time points of assessment. We judged one trial to be of high risk of bias, four as low risk of bias, and the others as raising some concerns. Based on intention-to-treat (ITT) population, antibiotics likely improved clinical cure (resolution of clinical symptoms or signs) by 26% (RR 1.26, 95% CI 1.09 to 1.46; 5 trials, 1474 participants; moderate certainty) as compared with placebo. Subgroup analysis showed no differences by antibiotic class (P = 0.67) or treatment duration (P = 0.60). In the placebo group, 55.5% (408/735) of participants had spontaneous clinical resolution by days 4 to 9 versus 68.2% (504/739) of participants treated with an antibiotic. Based on modified ITT population, in which participants were analyzed after randomization on the basis of positive microbiological culture, antibiotics likely increased microbiological cure (RR 1.53, 95% CI 1.34 to 1.74; 10 trials, 2827 participants) compared with placebo at the end of therapy; there were no subgroup differences by drug class (P = 0.60). No study evaluated the cost-effectiveness of antibiotic treatment. Patients receiving antibiotics had a lower risk of treatment incompletion than those in the placebo group (RR 0.64, 95% CI 0.52 to 0.78; 13 trials, 5573 participants; moderate certainty) and were 27% less likely to have persistent clinical infection (RR 0.73, 95% CI 0.65 to 0.81; 19 trials, 5280 participants; moderate certainty). There was no evidence of serious systemic side effects reported in either the antibiotic or placebo group (very low certainty). When compared with placebo, FQs (RR 0.70, 95% CI 0.54 to 0.90) but not non-FQs (RR 4.05, 95% CI 1.36 to 12.00) may result in fewer participants with ocular side effects. However, the estimated effects were of very low certainty.
AUTHORS' CONCLUSIONS: The findings of this update suggest that the use of topical antibiotics is associated with a modestly improved chance of resolution in comparison to the use of placebo. Since no evidence of serious side effects was reported, use of antibiotics may therefore be considered to achieve better clinical and microbiologic efficacy than placebo. Increasing the proportion of participants with clinical cure or increasing the speed of recovery or both are important for individual return to work or school, allowing people to regain quality of life. Future studies may examine antiseptic treatments with topical antibiotics for reasons of cost and growing antibiotic resistance.
OBJETIVO: Evaluar la seguridad y eficacia de olopatadina tópico versus placebo y otros medicamentos anti-alérgicas tópicos en el tratamiento de la conjuntivitis alérgica.
Métodos: Se realizaron búsquedas sistemáticas en la literatura para los ensayos controlados aleatorios que incluían pacientes con conjuntivitis alérgica, en comparación olopatadina en comparación con los medicamentos anti-alérgicas alternativas placebo o, y se examinaron prurito, hiperemia conjuntival, síntoma compuesto o firmar las puntuaciones, y / o la ocurrencia de eventos adversos . Se evaluó la seguridad y eficacia de olopatadina tópica en comparación con los medicamentos alternativos antialérgicos utilizando meta-análisis de placebo o.
RESULTADOS: En comparación con el placebo, la olopatadina tópica se asocia con una diferencia agrupada-media (MD) en picor ocular de -1,33 (p <0.00001) e hiperemia ocular de -0,92 (p <0.00001). Cuando se compara con otros agentes, olopatadina era inferior a alcaftadina el picor ocular (agrupada-MD = 0,39; p <0,00001), pero comparable a la epinastina y ketotifeno.
CONCLUSIONES: tópicas de olopatadina es una modalidad de tratamiento seguro y eficaz para la conjuntivitis alérgica, mientras que alcaftadina parece ser superior a la olopatadina en la reducción de la picazón ocular.
ANTECEDENTES: En los pacientes con ojos rojos, las enseñanzas tradicionales sugieren que la fotofobia, visión borrosa y dolor en los ojos indican una enfermedad ocular grave; en pacientes con presunta conjuntivitis, el hallazgo de drenaje purulento indica tradicionalmente una causa bacteriana. La precisión de estas enseñanzas es desconocida.
MÉTODOS: Una búsqueda en MEDLINE se realizó para recuperar los artículos publicados entre 1966 y abril de 2014 relevante para el diagnóstico de cabecera de la enfermedad ocular grave y conjuntivitis bacteriana.
RESULTADOS: En los pacientes con ojos rojos, los hallazgos más útiles que indican enfermedad ocular grave son anisocoria (con la pupila más pequeña en el ojo rojo y la diferencia entre los diámetros de pupila> 1 mm; razón de verosimilitud [LR], 6,5; intervalo de confianza del 95% [IC ], 2,6-16,3) y fotofobia, provocada por la iluminación directa (LR, 8,3; IC del 95%, 2,7-25,9), la iluminación indirecta (LR, 28,8; IC del 95%, 1,8 a 459), o cerca de prueba sinquinesis ( "dedo -to-nariz prueba de convergencia ", LR, 21,4; IC del 95%, 12-38,2). En los pacientes con presunta conjuntivitis, enrojecimiento completa de la membrana conjuntiva tarsal que oscurece vasos (LR, 4,6; IC del 95%, 1,2-17,1), se observa secreción purulenta (LR, 3,9; IC del 95%, 1.7 a 9.1), y esteras de ambos ojos en la mañana (LR, 3,6; IC del 95%, 1.9 a 6.5) aumentan la probabilidad de una causa bacteriana; la inobservancia de un ojo rojo en 20 pies (LR, 0,2; IC del 95%, 0-0,8) y ausencia de encolado de la mañana de uno de los ojos (LR, 0,3; IC del 95%, 0,1-0,8) disminuir la probabilidad de una causa bacteriana .
CONCLUSIONES: Varios hallazgos de noche distinguir con precisión grave de la enfermedad del ojo benigna en pacientes con ojos rojos y, en pacientes con presunta conjuntivitis, distinguir bacteriana por causas virales o alérgicas.
ANTECEDENTES: La queratitis bacteriana grave (BK) normalmente requiere tratamiento antibiótico intensivo. La terapia empírica es por lo general con una fluoroquinolona tópica o combinación aminoglucósidos cefalosporina fortificada. Los ensayos hasta la fecha no han llegado a ningún consenso en cuanto a qué régimen de antibióticos trata más efectivamente BK.
MÉTODOS: Una revisión sistemática y meta-análisis utilizando la metodología Cochrane se llevó a cabo para evaluar la eficacia de los antibióticos tópicos en el tratamiento de BK. Los resultados incluyeron el éxito del tratamiento, el tiempo para curar, las complicaciones graves de la infección y los efectos adversos.
RESULTADOS: Una búsqueda exhaustiva de ensayos resultaron en 27 956 resúmenes para su revisión. Esto a la larga resultó en 16 ensayos de alta calidad que implican 1.823 participantes incluidos en la revisión. El éxito del tratamiento, el tiempo para curar y las complicaciones graves de la infección fueron comparables entre todos los tratamientos antibióticos incluidos en la revisión. Además, no hubo pruebas de diferencias en el riesgo de perforación de la córnea con cualquier antibióticos incluidos o clases de antibióticos. Las fluoroquinolonas redujeron significativamente el riesgo de malestar ocular y conjuntivitis química, pero aumentó el riesgo de formación de precipitado blanco en comparación con aminoglucósidos cefalosporina. Fortificado tobramicina-cefazolina fue aproximadamente tres veces más probabilidades de causar molestias oculares que otros antibióticos tópicos.
CONCLUSIONES: Los resultados de esta revisión sugieren que no hay evidencia de diferencia en la eficacia comparativa entre las fluoroquinolonas y las opciones de tratamiento aminoglucósidos cefalosporina en la gestión de BK. Hubo diferencias en el perfil de seguridad, sin embargo. Las fluoroquinolonas redujeron el riesgo de malestar ocular y conjuntivitis química mientras ciprofloxacino aumentó el riesgo de blanco precipitado corneal en comparación con aminoglucósidos cefalosporina.
BACKGROUND: Histamine receptor activation and degranulation of mast cells are the mechanisms by which the ocular itching, hyperemia, chemosis, eyelid swelling, and tearing of seasonal allergic conjunctivitis are induced. Some of the topical solutions available as anti-allergy therapies are intended to interfere with these mechanisms, and the body of research regarding the capabilities of these therapeutic molecules continues to expand.
OBJECTIVE: To review the currently available literature regarding one topical ophthalmic anti-allergy agent, olopatadine (Patanol), and its anti-histaminic and mast cell stabilizing actions, both in pre-clinical and clinical settings.
DESIGN AND METHODS: Relevant research of laboratory, animal model, and clinical trial studies performed using olopatadine was reviewed. MEDLINE literature searches were conducted and supplemented by additional reports which furthered relevant discussion or were necessary to verify the information resulting from original searches.
RESULTS: Olopatadine demonstrates unique properties both pre-clinically and clinically which differentiate it from other therapeutic molecules in its class of dual action mast cell stabilizer/anti-histamine. Its non-perturbation of cell membranes, human conjunctival mast cell stabilization in vivo and in vitro, and superior efficacy as compared to other topical anti-allergic medications including mast cell stabilizers, anti-histamines, and dual action agents, all contribute to olopatadine's profile.
CONCLUSIONS: Peer-reviewed literature suggests that olopatadine is clinically superior to the other anti-allergic molecules because of its strong anti-histaminic qualities and its unique ocular mast cell stabilizing properties.
Acute bacterial conjunctivitis is an infection of the conjunctiva and is one of the most common ocular disorders in primary care. Antibiotics are generally prescribed on the basis that they may speed recovery, reduce persistence, and prevent keratitis. However, many cases of acute bacterial conjunctivitis are self-limited, resolving without antibiotic therapy. This Cochrane Review was first published in The Cochrane Library in 1999, then updated in 2006, 2012, and 2022.
OBJECTIVES:
To assess the benefits and side effects of antibiotic therapy in the management of acute bacterial conjunctivitis.
SEARCH METHODS:
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2022, Issue 5), MEDLINE (January 1950 to May 2022), Embase (January 1980 to May 2022), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.
CLINICALTRIALS:
gov), and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases in May 2022.
SELECTION CRITERIA:
We included randomized controlled trials (RCTs) in which any form of antibiotic treatment, with or without steroid, had been compared with placebo/vehicle in the management of acute bacterial conjunctivitis. This included topical and systemic antibiotic treatments.
DATA COLLECTION AND ANALYSIS:
Two authors independently reviewed the titles and abstracts of identified studies. We assessed the full text of all potentially relevant studies and determined the included RCTs, which were further assessed for risk of bias using Cochrane methodology. We performed data extraction in a standardized manner and conducted random-effects meta-analyses using RevMan Web.
MAIN RESULTS:
We included 21 eligible RCTs, 10 of which were newly identified in this update. A total of 8805 participants were randomized. All treatments were topical in the form of drops or ointment. The trials were heterogeneous in terms of their eligibility criteria, the nature of the intervention (antibiotic drug class, which included fluoroquinolones [FQs] and non-FQs; dosage frequency; duration of treatment), the outcomes assessed and the time points of assessment. We judged one trial to be of high risk of bias, four as low risk of bias, and the others as raising some concerns. Based on intention-to-treat (ITT) population, antibiotics likely improved clinical cure (resolution of clinical symptoms or signs) by 26% (RR 1.26, 95% CI 1.09 to 1.46; 5 trials, 1474 participants; moderate certainty) as compared with placebo. Subgroup analysis showed no differences by antibiotic class (P = 0.67) or treatment duration (P = 0.60). In the placebo group, 55.5% (408/735) of participants had spontaneous clinical resolution by days 4 to 9 versus 68.2% (504/739) of participants treated with an antibiotic. Based on modified ITT population, in which participants were analyzed after randomization on the basis of positive microbiological culture, antibiotics likely increased microbiological cure (RR 1.53, 95% CI 1.34 to 1.74; 10 trials, 2827 participants) compared with placebo at the end of therapy; there were no subgroup differences by drug class (P = 0.60). No study evaluated the cost-effectiveness of antibiotic treatment. Patients receiving antibiotics had a lower risk of treatment incompletion than those in the placebo group (RR 0.64, 95% CI 0.52 to 0.78; 13 trials, 5573 participants; moderate certainty) and were 27% less likely to have persistent clinical infection (RR 0.73, 95% CI 0.65 to 0.81; 19 trials, 5280 participants; moderate certainty). There was no evidence of serious systemic side effects reported in either the antibiotic or placebo group (very low certainty). When compared with placebo, FQs (RR 0.70, 95% CI 0.54 to 0.90) but not non-FQs (RR 4.05, 95% CI 1.36 to 12.00) may result in fewer participants with ocular side effects. However, the estimated effects were of very low certainty.
AUTHORS' CONCLUSIONS:
The findings of this update suggest that the use of topical antibiotics is associated with a modestly improved chance of resolution in comparison to the use of placebo. Since no evidence of serious side effects was reported, use of antibiotics may therefore be considered to achieve better clinical and microbiologic efficacy than placebo. Increasing the proportion of participants with clinical cure or increasing the speed of recovery or both are important for individual return to work or school, allowing people to regain quality of life. Future studies may examine antiseptic treatments with topical antibiotics for reasons of cost and growing antibiotic resistance.
