Source:

Honkila
M
,
Koskela
U
,
Kontiokari
T
, et al
.
Effect of topical antibiotics on duration of acute infective conjunctivitis in children: a randomized clinical trial and a systematic review and meta-analysis
.
JAMA Network Open
.
2022
;
5
(
10
):
e2234459
. doi:
https://doi.org/10.1001/jamanetworkopen.2022.34459

Investigators from multiple institutions in Finland conducted a randomized controlled trial (RCT), followed by a meta-analysis, to assess the efficacy of antibiotic eye drops in children with acute conjunctivitis. For the RCT, children 6 months to 7 years old with acute conjunctivitis, defined as the presence of conjunctival erythema, discharge, or soreness or swelling of the eyelids, were enrolled at 1 of 3 outpatient sites in Oulu, Finland, from October 15, 2014 to February 7, 2020. At enrollment, bacterial cultures of the conjunctivae were obtained from participants. Study children were randomized in a 1:1:1 fashion to a moxifloxacin (5 mg/mL) or placebo eye drops treatment group or a no treatment group. For those receiving moxifloxacin or placebo, 1 drop was administered 3 times daily to the affected eye until conjunctival symptoms were absent for 24 hours, up to a maximum of 7 days. Parents of children in all 3 treatment groups recorded conjunctival symptoms for 14 days. The primary study outcome was time until resolution of conjunctival symptoms without relapse for 2 days. Time until resolution was compared in the 3 groups using 1-way analysis of variance.

The authors also conducted a systematic search to identify published RCTs that assessed the effectiveness of antibiotic eye drops for treatment of acute conjunctivitis that included patients 1 month to 18 years old. The results of the identified studies and those of the current RCT were combined. The primary outcome was proportion of participants in the antibiotic or placebo eye drops groups who had conjunctival symptoms 3-6 days after beginning treatment; an odds ratio [OR] and 95% CI were calculated to compare the difference between groups.

For the RCT, data on 88 participants, including 30 randomized to moxifloxacin, 27 in the placebo group, and 31 in the no treatment group, were analyzed. The mean ages of children in the 3 treatment groups were 2.8 ±1.6, 3.0 ±1.3, and 3.2 ±1.8 years, respectively. Overall, 83.3% of participants had a positive bacterial conjunctival culture, with Haemophilus influenzae the most common pathogen. Time to clinical cure was significantly shorter in children receiving moxifloxacin drops than those in the no treatment group (mean, 3.8 ±3.1 vs 5.7 ±3.3 days; P = 0.04). Mean time to clinical cure for children in the placebo group was 4.0 ±2.3 days, which was not significantly different from that of those randomized to moxifloxacin (P = 0.94). For the meta-analysis, data on 584 children from the current study and 3 previous RCTs were analyzed. The proportion of children in these studies who were symptomatic on days 3-6 was significantly lower among those receiving antibiotic drops than in placebo recipients (OR, 0.59; 95% CI, 0.39, 0.91).

The authors conclude that...

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