Sheikh A, Hurwitz B
University of Edinburgh, Division of Community Health Sciences: GP Section, 20 West Richmond Street, Edinburgh, UK, EH8 9DX.
Cochrane Database Syst Rev. 2006 Apr 19(2):CD001211. doi: 10.1002/14651858.CD001211.pub2.
There are concerns about whether antibiotic therapy confers significant clinical benefit in the treatment of acute bacterial conjunctivitis.
The aim of this review was to assess the benefit and harm of antibiotic therapy in the management of acute bacterial conjunctivitis.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register), MEDLINE, EMBASE, SIGLE, NRR, PubMed and the reference lists of identified trial reports. We used the Science Citation Index to look for articles that cited the relevant studies, and we contacted investigators and pharmaceutical companies for information about additional trials.
We included double masked randomised controlled trials in which any form of antibiotic treatment had been compared with placebo in the management of acute bacterial conjunctivitis. This included topical, systemic and combination (for example, antibiotics and steroids) antibiotic treatments.
One author extracted data and the accuracy was checked by a second author.
This review includes five trials which randomised a total of 1034 participants. One further trial is currently 'awaiting assessment'. This has been published in abstract form and has yet to be fully reported. Three of the trials have been conducted on a selected specialist care patient population and the two more recent trials have been conducted in a community care setting. The trials were heterogeneous in terms of their inclusion and exclusion criteria, the nature of the intervention, and the outcome measures assessed. Meta-analyses of data on clinical and microbiological remission rates reveal that topical antibiotics are of benefit in improving early (days 2 to 5) clinical (RR 1.24, 95% CI 1.05 to 1.45) and microbiological (RR 1.77, 95% CI 1.23 to 2.54) remission rates; later (days 6 to 10) data reveal that these early advantages in clinical (RR 1.11, 95% CI 1.02 to 1.21) and microbiological cure rates are reduced (RR 1.56, 95% CI 1.17 to 2.09), but persist. Most cases however resolve spontaneously with clinical remission being achieved in 65% (95% CI 59 to 70) by days 2 to 5 in those receiving placebo. No serious outcomes were reported in either the active or placebo arms of these trials, indicating that important sight-threatening complications are an infrequent occurrence.
AUTHORS' CONCLUSIONS: Acute bacterial conjunctivitis is frequently a self-limiting condition, but the use of antibiotics is associated with significantly improved rates of clinical and microbiological remission.
对于抗生素治疗在急性细菌性结膜炎治疗中是否能带来显著临床益处存在担忧。
本综述的目的是评估抗生素治疗在急性细菌性结膜炎管理中的益处和危害。
我们检索了Cochrane对照试验中央注册库（CENTRAL）（其中包含Cochrane眼科和视力组试验注册库）、MEDLINE、EMBASE、SIGLE、NRR、PubMed以及已识别试验报告的参考文献列表。我们使用科学引文索引查找引用相关研究的文章，并联系研究人员和制药公司获取关于其他试验的信息。
我们纳入了双盲随机对照试验，其中在急性细菌性结膜炎管理中将任何形式的抗生素治疗与安慰剂进行了比较。这包括局部、全身和联合（例如抗生素和类固醇）抗生素治疗。
由一位作者提取数据，另一位作者检查准确性。
本综述包括五项试验，共随机分配了1034名参与者。另一项试验目前正在“等待评估”。该试验已以摘要形式发表，但尚未完全报告。其中三项试验是在选定的专科护理患者人群中进行的，另外两项较新的试验是在社区护理环境中进行的。这些试验在纳入和排除标准、干预性质以及评估的结局指标方面存在异质性。对临床和微生物学缓解率数据的荟萃分析表明，局部抗生素有助于提高早期（第2至5天）临床（RR 1.24，95%CI 1.05至1.45）和微生物学（RR 1.77，95%CI 1.23至2.54）缓解率；后期（第6至10天）数据表明，这些在临床（RR 1.11，95%CI 1.02至1.21）和微生物学治愈率方面的早期优势有所降低（RR 1.56，95%CI 1.17至2.09），但仍然存在。然而大多数病例会自行缓解，接受安慰剂治疗的患者在第2至5天临床缓解率达到65%（95%CI 59至70）。这些试验的活性治疗组或安慰剂组均未报告严重结局，表明威胁视力的重要并发症很少发生。
急性细菌性结膜炎通常是一种自限性疾病，但使用抗生素与临床和微生物学缓解率的显著提高相关。
