coo conjunctivitis bacterial v10 - 040717 with lay summary

8/18/2019 Coo Conjunctivitis Bacterial v10 - 040717 With Lay Summary

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CLINICAL MANAGEMENT GUIDELINES

Conjunctivitis (bacterial)

Conjunctivitis (bacterial)Version 10, Page 1 of 3Date of search 03.01.14; Date of revision 17.06.14; Date of publication 04.07.14; Date for review 02.01.16

© College of Optometrists

Aetiology Bacterial infection of the conjunctiva, typically by: Staphylococcus species Streptococcus pneumoniae Haemophilus influenzae

Moraxella catarrhalisPredisposing factors Children and the elderly have an increased risk of infective conjunctivitis

(NB Bacterial conjunctivitis in the first 28 days of life is a seriouscondition that must be referred urgently to the ophthalmologist. SeeClinical Management Guideline on Ophthalmia Neonatorum)

contamination of the conjunctival surface superficial trauma contact lens wear (NB infection may be Gram –ve) secondary to viral conjunctivitis recent cold, upper respiratory tract infection [NB refer also to

Clinical Management Guideline on Conjunctivitis (viral, non-

herpetic)] or sinusitis diabetes (or other disease compromising the immune system) steroids (systemic or topical, compromising ocular resistance to

infection) blepharitis (or other chronic ocular inflammation)

Symptoms Acute onset of: redness discomfort, usually described as burning or grittiness discharge (may cause temporary blurring of vision) crusting of lids (often stuck together after sleep and may have to

be bathed openUsually bilateral – one eye may be affected before the other (by one ortwo days)

Signs lid crusting purulent or mucopurulent discharge conjunctival hyperaemia – maximal in fornices tarsal conjunctiva may show mild papillary reaction cornea: usually no involvement (occasionally SPK – mainly in

lower third of cornea). If cornea significantly involved, considerpossibility of gonococcal infection

(pre-auricular lymphadenopathy: usually absent) Differential diagnosis Other forms of conjunctivitis

epidemic keratoconjunctivitis (e.g. adenovirus) Herpes (simplex or zoster) Chlamydial infection allergy

Other causes of acute red eye angle closure glaucoma infective keratitis anterior uveitis

Management by Optometrist Practitioners should recognise their limitations and where necessary seek further advice or referthe patient elsewhere Non pharmacological Often resolves in 5-7 days without treatment

Bathe/clean the eyelids with lint or cotton wool dipped in sterile saline orboiled (cooled) water to remove crusting (GRADE*: Level of evidence =


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low, Strength of recommendation = strong) Advise patient that condition is contagious (do not share towels, etc.)

Pharmacological Treatment with topical antibiotic may improve short-term outcome andrender patient less infectious to others (GRADE*: Level of evidence =

high, Strength of recommendation = strong). This recommendation isbased on the conclusions of a recent Cochrane Review (Sheikh andHurwitz 2012) which included trials conducted in primary and secondarycare. However, an individual patient meta-analysis of studies exclusivelybased in primary care (Jefferis et al 2011) found only a marginal benefitof antibiotics over placebo. Patients with purulent discharge or a mildseverity of red eye were found to benefit most from treatment.

Alternatives include: chloramphenicol 0.5% drops 2-hourly for 2 days, then 4 times

daily for 5 days) chloramphenicol 1% ointment four times daily for 2 days, then

twice daily for 5 days fusidic acid 1% eye drops twice daily for 7 days

Contact lens wearers with a diagnosis of bacterial conjunctivitis shouldbe treated with a topical antibiotic effective against Gram –ve organisms,e.g. gutt ofloxacin 0.3% qds for up to 10 days. Contact lenses should notbe worn during the treatment period

Advise patient to return/seek further help if symptoms persist beyond 7days

Management Category B3 : Management to resolutionRefer if condition fails to resolve, or if there is corneal involvement

Possible management by Ophthalmologist If resistant to treatment, or recurrent,

conjunctival swabs taken for microscopy and culture and/or PCRanalysis

treatment with other antibiotics, based on culture resultsEvidence base

* GRADE: Grading of Recommendations, Assessment, Development and Evaluation

Sources of evidenceSheikh A, Hurwitz B, van Schayck CP,McLean S, Nurmatov U.

Antibiotics versus placebo for acute bacterial conjunctivitis.

Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.:CD001211

Jefferis J. Perera R. Everitt H. van Weert H. Rietveld R. Glasziou P.Rose P.Acute infective conjunctivitis in primary care: who needsantibiotics? An individual patient data meta-analysis. [Review] BritishJournal of General Practice 2011; 61(590):e542-8

Lay summary Acute bacterial conjunctivitis is an infection of the eye in which one or both eyes become red withassociated discomfort. The condition is not normally serious and in most cases clears up withouttreatment. People with acute conjunctivitis are often given antibiotics, usually in the form of eye


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drops or ointment, to speed recovery. However,the benefits of antibiotics for the treatment ofbacterial conjunctivitis have been questioned. A review of randomised clinical trials comparingantibiotic eye drops to placebo concluded that antibiotics can speed up the resolution of acuteconjunctivitis However, the benefits are less clear when the results of trials conducted exclusively

in community GP practices are considered, since these patients tend to have a less severe form ofconjunctivitis than would be expected in hospital practice.

coo conjunctivitis bacterial v10 - 040717 with lay summary

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