Topical antibiotics work well against acute infectious conjunctivitis in children

Treatment with topical antibiotics in children with acute infectious conjunctivitis shortens time to clinical cure and helps resolve symptoms as early as 3 days, as reported in a study.

In a randomized controlled trial (RCT) involving 88 children (52 percent girls), clinical cure occurred much sooner among those who received moxifloxacin eye drops vs no intervention (3.8 vs 5.7 days; difference, −1.9 days, 95 percent confidence interval [CI], −3.7 to −0.1; p=0.04). [JAMA Netw Open 2022;5:e2234459]

Time to clinical cure did not differ between the moxifloxacin and the placebo eye drop groups (3.8 vs 4.0 days; difference, 0.2 days, 95 percent CI, –2.2 to 1.6 days; p=0.94), as well as between the placebo eye drop and no-intervention groups (4.0 vs 5.7 days; difference, 1.7 days, 95 percent CI, –0.2 to 3.5 days; p=0.10).

Kaplan-Meier survival analysis showed that both moxifloxacin and placebo eye drops were associated with significantly shorter time to clinical cure relative to no intervention (p=0.02 and p=0.03, respectively).

The moxifloxacin eye drop group comprised 30 children (mean age 2.8 years), the placebo eye drop group 27 children (mean age 3.0 years), and the no-intervention group 31 children (mean age 3.2 years).

“These findings suggest that topical antibiotic therapy should be considered for acute infective conjunctivitis in children because antibiotics were associated with significantly shorter recovery times,” according to the investigators.

Meta-analysis

“Acute conjunctivitis is a common infection in children and is usually caused by bacteria. Physicians often prescribe antibiotics for this ailment, although the evidence for their effectiveness in paediatric patients is limited and conflicting,” they said. [J Pediatr 1993;122:10-14; BMC Fam Pract 2007;8:54]

For example, one study in the early 1980s reported that treatment with polymyxin-bacitracin eye drops yielded higher clinical cure rates on days 2–5 as compared with a placebo. On the other hand, a large trial conducted in 2005 found no significant difference in the cure rates at week 1 between the children treated with chloramphenicol eye drops and those treated with placebo eye drops. [J Pediatr 1984;104:623-626; Lancet 2005;366:37-43]

To address such inconsistencies, the investigators conducted a meta-analysis that included four studies, including the current trial and the other two mentioned studies, and involved a total of 584 children (300 treated with topical antibiotics and 284 with a placebo).

Pooled data showed that compared with placebo eye drops, topical antibiotics was associated with a significant reduction in the proportion of children who were symptomatic on days 3–6 (odds ratio [OR], 0.59, 95 percent CI, 0.39–0.91), as well as in the proportion of those who had a positive bacterial culture from the conjunctivae on days 7–10 (OR, 0.34, 95 percent CI, 0.17–0.68; p=0.003).

“An acknowledged weakness of previous RCTs has been that none of the trials have included a control group without an intervention. It has been suggested that placebo eye drops alone may be of benefit in the management of acute infective conjunctivitis because of their washout effect. Moreover, the largest trial of which we are aware found no difference in cure times between antibiotic eye drops and a placebo, but it included a placebo solution that contained preservatives with antiseptic properties,” according to the investigators. [J Pediatr 1984;104:623-626; Lancet 2005;366:37-43]  

The present study avoided the bias caused by washout or anti-infective effects of a placebo by including groups with no intervention at all and a placebo solution that did not contain any preservatives.

“As a result, the placebo eye drops significantly reduced the time to clinical cure in the present time-to-event analysis by comparison with no treatment, although the difference in the mean times to clinical cure between the groups was not statistically significant. These findings do suggest, however, that lubricating eye drops may make some contribution to the management of acute infective conjunctivitis in children,” the investigators pointed out.