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Antimicrobial Agents in Conjunctivitis

      To the Editor:
      Wirbelauer’s Update in Office Management is a helpful overview.
      • Wirbelauer C.
      Management of the red eye for the primary care physician.
      I am concerned, however, that in his discussion of viral conjunctivitis, the author recommends prescribing antibiotic eyedrops “to prevent secondary bacterial infection.” Although it is common practice among primary care practitioners to prescribe antimicrobial agents in this setting,
      • Everitt H.
      • Little P.
      How do GPs diagnose and manage acute infective conjunctivitis? A GP survey.
      there is no evidence that patients with viral conjunctivitis are at any risk of bacterial superinfection. The American Academy of Ophthalmology recommends against using antibiotics in the setting of viral conjunctivitis.
      In addition, even bacterial conjunctivitis is generally a self-limiting condition not requiring the use of antibiotics.
      • David S.P.
      Should we prescribe antibiotics for acute conjunctivitis?.
      Prescribing antimicrobial agents for pinkeye is perhaps not the most egregious example of the overuse of antibiotics, but given the great need for patient education about limiting antibiotic use in general, it seems unfortunate to miss any opportunity to do so.

      References

        • Wirbelauer C.
        Management of the red eye for the primary care physician.
        Am J Med. 2006; 119: 302-306
        • Everitt H.
        • Little P.
        How do GPs diagnose and manage acute infective conjunctivitis?.
        Fam Pract. 2002; 19: 658-660
      1. American Academy of Ophthalmology Conjunctivitis Guideline. 2003 (Available at: http://www.aao.org/education/library/ppp/conjunctivitis_new.cfm.)
        • David S.P.
        Should we prescribe antibiotics for acute conjunctivitis?.
        Am Fam Physician. 2002; 66: 1649-1650

      Linked Article

      • The Reply:
        The American Journal of MedicineVol. 120Issue 8
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          I thank Headly for her interest and comments on the subject of antimicrobial therapy to prevent superinfection in viral conjunctivitis. This has raised an important and controversial point on how to treat this red eye condition. I fully agree that antibiotics, in this case administered as eyedrops, should be prescribed judiciously to avoid overuse and the development of widespread antimicrobial resistance. In the presented update on the management of red eye symptoms1 it was recommended to use antibiotic coverage, because it is sometimes difficult to differentiate the exact cause for conjunctivitis in the clinical practice setting, even for ophthalmologists.
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