Antibiotics No Good for Pinkeye

Study finds this childhood malady usually clears up on its own

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HealthDay Reporter

WEDNESDAY, June 22, 2005 (HealthDay News) -- The common childhood infection known as pinkeye does not respond to antibiotics, a new British study finds.

Instead, parents should simply let conjunctivitis clear up on its own, the researchers report in the June 21 online issue of The Lancet.

"Conjunctivitis is a mild and self-limiting condition and does not need specific treatment, therefore it is wrong to continue to medicalize it," said study author Dr. Peter Rose, a university lecturer in the department of primary health care at the University of Oxford.

The findings, however, are probably not enough to change current practice, according to American experts.

"I don't think we should change our treatment parameters quite yet, but this is food for thought and further study," said Dr. Craig McKeown, a pediatric ophthalmologist at Bascom Palmer Eye Institute of the University of Miami School of Medicine.

Dr. Eduardo Alfonso, director of the ocular microbiology lab at Bascom, took issue with some aspects of the study.

"I have a problem with the placebo they used in this study because it is an antiseptic. They both kill organisms," he said. In other words, the placebo may have had an effect on the infection.

Also, many times an antibiotic will resolve conjunctivitis in one or two days, rather than seven.

"I would rather have a kid get over the infection in two days," Alfonso said. And kids still need to be seen by a doctor in case they have another related and more serious infection in other parts of their body.

Pinkeye is a common condition affecting about 5 million schoolchildren in the United States, or one in eight children annually. It's characterized by an inflammation of the conjunctiva, the clear membrane covering the white part of the eye.

Conjunctivitis can be caused either by bacteria or viruses, but doctors often have trouble differentiating the causes. Many will prescribe antibiotic eye drops, despite a lack of evidence to support this practice. Antibiotics are ineffective against viruses.

Antibiotic overuse can have serious consequences for public health, however. Overprescribing contributes to the development of resistant bacteria, and many experts are trying to find ways to cut down on the unnecessary use of these drugs.

The idea of whether or not to use antibiotics for conjunctivitis, McKeown said, "has been long questioned because there are other forms of conjunctivitis. It's been sort of a shotgun approach with antibiotics."

This trial was designed to compare the effectiveness of chloramphenicol eye drops -- the most commonly used prescription antibiotic for conjunctivitis in the United Kingdom -- with a placebo in children who had pinkeye.

Chloramphenicol eye drops will soon be available over-the-counter in the United Kingdom; it will be the first antibiotic to be available without a prescription in that country.

According to Alfonso, chloramphenicol is banned in the United States. "We would never think of treating a child with chloramphenicol," he said.

In all, 326 British children aged 6 months to 12 years with a clinical diagnosis of conjunctivitis were randomly assigned to either the treatment or a placebo.

After seven days, the researchers found no significant difference in the cure rate, with 86 percent of the children in the antibiotic group cured vs. 83 percent in the placebo group.

Findings were similar among children known to have a bacterial form of conjunctivitis: The researchers report a cure rate of 85 percent in the antibiotic group and 80 percent in the placebo group.

In other words, children taking the drops cut about half a day off their infection. But that small gain, the authors argued, is not enough to balance the health-care costs involved, including 1 million visits to primary-care physicians each year in the United Kingdom.

Although the researchers suggested that parents initially treat children themselves without seeing a doctor, such a tactic may be difficult to implement among school-age children in the United States, one expert said.

"There are usually nurses based in the school, but we don't diagnose. We have to send anyone with a true pinkeye to a doctor," said Lucille Golembiewski, a supervising registered nurse at the Block Institute preschool in New York City. "They decide how to treat the child."

What's more, Golembiewski said, the school cannot accept the child back unless the infection has cleared.

In the United Kingdom, Rose explained, many child-care facilities and schools exclude children with conjunctivitis even though the national public health service advises against this.

"The exclusion policy results in loss of schooling for children and loss of work for parents who have to care for their children," Rose said. "There may need to be education of children and schools to change this exclusion policy, so that parents do not feel pressured to seek antibiotic treatment."

More information

The Nemours Foundation has more on pinkeye.

SOURCES: Peter Rose, M.D., University Lecturer, Department of Primary Health Care, University of Oxford, England; Eduardo Alfonso, M.D., director, ocular microbiology lab, and Craig McKeown, M.D., pediatric ophthalmologist, both of Bascom Palmer Eye Institute, University of Miami Miller School of Medicine; Lucille Golembiewski, R.N., supervising registered nurse, Block Institute preschool, New York City; June 21, 2005, The Lancet online

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