Topical Antibiotics Linked With Reduced Duration of Acute Infective Conjunctivitis in Children

Use of moxifloxacin eye drops was associated with significantly shorter durations of conjunctival symptoms in children with acute infective conjunctivitis, according to study findings published today in JAMA Network Open.

Although physicians often prescribe antibiotics for acute conjunctivitis, a common infection in children typically caused by pathogenic bacteria, researchers note that evidence for their effectiveness in pediatric patients is limited and conflicting.

“To our knowledge, all previous meta-analyses showing modest beneficial effects of topical antibiotics have combined pediatric and adult patients,” added the study authors.

In seeking to address these investigative limitations, they conducted a randomized clinical trial (RCT) to compare the efficacy of topical antibiotics (moxifloxacin eye drops) vs placebo in children aged 6 months to 7 years with acute infective conjunctivitis from 2 pediatric outpatient clinics in the city of Oulu and at the pediatric emergency department of Oulu University Hospital, Oulu, Finland, from October 15, 2014, to February 7, 2020.

An additional control group that received no intervention was also included “because placebo eye drops alone may be beneficial due to their washout effect,” explained researchers.

Participants were randomized 1:1:1 to receive moxifloxacin eye drops, placebo eye drops, or no intervention and were examined for the primary outcome of time (days) to clinical cure, defined as resolution of all conjunctival symptoms without relapse for 2 days, and the secondary outcome of relapse of conjunctivitis within 14 days of randomization. Eye drops were administered as 1 drop in each affected eye 3 times daily until conjunctival symptoms were absent for at least 24 hours. The maximum duration of treatment was 7 days.

“The outcomes were identified from the daily symptom sheet diaries that the parents completed for 14 days. In addition, the physician contacted the parents after the 14-day follow-up to ensure a clinical cure.”

The study was then continued by performing a systematic review and meta-analysis of data extracted from the present trial and previous RCTs. The primary outcome for the meta-analysis was the proportion of participants with conjunctival symptoms on days 3 to 6.

A total of 88 participants (52% girls) were included in the RCT, of whom 30 were randomized to moxifloxacin eye drops (mean [SD] age, 2.8 [1.6] years), 27 to placebo eye drops (mean [SD] age, 3.0 [1.3] years), and 31 to no intervention (mean [SD] age, 3.2 [1.8] years).

Compared with the no intervention group, the time to clinical cure was significantly shorter in the moxifloxacin eye drop group (3.8 vs 5.7 days; difference, −1.9 days; 95% CI, −3.7 to −0.1 days; P = .04), while in the survival analysis both moxifloxacin and placebo eye drops significantly shortened the time to clinical cure relative to no intervention.

There was no difference in the time to clinical cure for children given moxifloxacin eye drops or placebo (3.8 vs 4.0 days; difference, 0.2 days; 95% CI, –2.2 to 1.6 days; P = .94).

A total of 584 children were randomized in the meta-analysis (300 to topical antibiotics and 284 to a placebo). Findings showed that use of topical antibiotics was associated with a significant reduction in the proportion of children who had symptoms of conjunctivitis on days 3 to 6 compared with placebo eye drops (odds ratio, 0.59; 95% CI, 0.39-0.91; P = .02).

Researchers noted that the placebo solutions used in the 4 trials included in the meta-analysis varied and possible differences between them could not be assessed. The inability to compare the efficacy of topical antibiotic therapy separately in children with bacterial and viral conjunctivitis was also cited as a limitation of the study.

They concluded that findings of the present RCT also suggest that lubricating eye drops may have some benefits for the management of acute infective conjunctivitis in children.

Reference

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 Netw Open. 2022;5(10):e2234459. doi:10.1001/jamanetworkopen.2022.34459