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Antibiotics versus placebo for acute bacterial conjunctivitis

Chen, Yu-Yen, Liu, Su-Hsun, Nurmatov, Ulugbek ORCID:, van Schayck, Onno C. P. and Kuo, Irene C. 2023. Antibiotics versus placebo for acute bacterial conjunctivitis. The Cochrane Library 2023 (3) 10.1002/14651858.CD001211.pub4

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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) (, (, and the WHO International Clinical Trials Registry Platform (ICTRP) ( 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.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Medicine
Publisher: Wiley-Blackwell
ISSN: 1465-1858
Date of First Compliant Deposit: 26 June 2023
Date of Acceptance: 13 March 2023
Last Modified: 29 Jun 2023 15:21

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