A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice
A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice
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DOI：
10.1136/bmj.38891.551088.7c
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发表时间：
2006-08-12
影响因子：
105.7
通讯作者：
Smith, Peter W. F.
中科院分区：
文献类型：
--
作者：
Everitt, Hazel A.;Little, Paul S.;Smith, Peter W. F.
目的评价急性感染性结膜炎的不同治疗策略。设计开放、析因、随机对照试验。在英格兰南部设置30个全科诊所。参与者307名成人和儿童急性感染性结膜炎。干预三种抗生素处方策略之一-立即使用抗生素（氯霉素滴眼液; n = 104），无抗生素（对照组; n = 94），或延迟抗生素（n = 109）;患者信息传单或没有;和眼拭子或没有。主要结果测量咨询后第1-3天症状的严重程度，症状的持续时间，结果处方策略不影响症状的严重程度，但影响中度症状的持续时间使用抗生素的情况更少：未使用抗生素（对照组）4.8天，立即使用抗生素3.3天（风险比0.7，95%置信区间0.6至0.8），延迟使用抗生素3.9天（0.8，0.7至0.9）。与初始不提供抗生素相比，直接使用抗生素组的抗生素使用率较高：对照组为30%，直接使用抗生素组为99%（优势比185.4，23.9至1439.2），延迟抗生素53%（2.9，1.4至5.7），正如对抗生素有效性的信念一样：控制47%，立即使用抗生素67%（比值比2.4，1.1至5.0），延迟抗生素55%（1.4，0.7至3.0），并打算重新处理眼部感染：控制40%，立即抗生素68%（3.2，1.6至6.4），延迟抗生素41%（1.0，0.5至2.0）。患者须知页或眼拭子对主要结局无影响。延迟抗生素组与立即抗生素组相比，两周内的复诊率较低：0.3（0.1至1.0）v 0.7（0.3至1.6）。结论延迟抗生素处方可能是管理初级保健中急性结膜炎最合适的策略。它减少了抗生素的使用，没有药物治疗的证据，提供了类似的持续时间和症状的严重程度，立即处方，并减少了眼部感染的复发。
Objective To assess different management strategies for acute infective conjunctivitis.Design Open, factorial, randomised controlled trial.Setting 30 general practices in southern England.Participants 307 adults and children with acute infective conjunctivitis.Intervention One of three antibiotic prescribing strategies-immediate antibiotics (chloramphenicol eye drops; n = 104), no antibiotics (controls; n = 94), or delayed antibiotics (n = 109); a patient information leaflet or not; and an eye swab or not.Main outcome measures Severity of symptoms on days 1-3 after consultation, duration of symptoms, and belief in the effectiveness of antibiotics for eye infections.Results Prescribing strategies did not affect the severity of symptoms but duration of moderate symptoms was less with antibiotics: no antibiotics (controls) 4.8 days, immediate antibiotics 3.3 days (risk ratio 0.7, 95% confidence interval 0.6 to 0.8), delayed antibiotics 3.9 days (0.8, 0.7 to 0.9). Compared with no initial offer of antibiotics, antibiotic use was higher in the immediate antibiotic group: controls 30%, immediate antibiotics 99% (odds ratio 185.4, 23.9 to 1439.2), delayed antibiotics 53% (2.9, 1.4 to 5.7), as was belief in the effectiveness of antibiotics: controls 47%, immediate antibiotics 67% (odds ratio 2.4, 1.1 to 5.0), delayed antibiotics 55% (1.4, 0.7 to 3.0), and intention to reattend for eye infections: controls 40%, immediate antibiotics 68% (3.2, 1.6 to 6.4), delayed antibiotics 41% (1.0, 0.5 to 2.0). A patient information leaflet or eye swab had no effect on the main outcomes. Reattendance within two weeks was less in the delayed compared with immediate antibiotic group: 0.3 (0.1 to 1.0) v 0.7 (0.3 to 1.6).Conclusions Delayed prescribing of antibiotics is probably the most appropriate strategy for managing acute conjunctivitis in primary care. It reduces antibiotic use, shows no evidence of medicalisation, provides similar duration and severity of symptoms to immediate prescribing, and reduces reattendance for eye infections.