The problem with studying treatment for acute bacterial conjunctivitis is making sure that only bacterial cases are included, and not viral, chlamydial, allergic, etc. Treatment generally starts before microbiological confirmation of a bacterial cause.
The study by Rietveld et al1 shows that fusidic acid is similar to placebo in the treatment of ‘all-comers’ with an acute conjunctivitis. It is important to note that most of these cases were not bacterial conjunctivitis – nearly 70% had no isolation of a bacterial pathogen. It is therefore to be expected that fusidic acid would not be effective for the majority of these patients. Nevertheless, the study is useful in that it provides no support for blind prescription of fusidic acid for acute conjunctivitis of undetermined cause.
The study was not meant, however, to address the treatment of acute conjunctivitis caused by bacteria. I was therefore surprised to find the study being used to support the conclusions of Professors Sheikh and Hurwitz in the same issue,2 relating to the treatment of acute bacterial conjunctivitis specifically.
- © British Journal of General Practice, 2006.