Diagnostic impact of signs and symptoms in acute infectious conjunctivitis: systematic literature search
Diagnostic impact of signs and symptoms in acute infectious conjunctivitis: systematic literature search
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DOI：
10.1136/bmj.327.7418.789
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发表时间：
2003-10-04
影响因子：
--
通讯作者：
Bindels, PJE
中科院分区：
文献类型：
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作者：
Rietveld, RP;van Weert, HCPM;Bindels, PJE
在急性感染性结膜炎中，全科医生必须区分细菌性病因和病毒性病因，以选择最有可能从抗生素治疗中获益的患者。医生根据症状和体征进行区分。其他诊断性检查，如结膜培养，很少进行，主要是因为结果延迟了几天。大多数治疗试验表明，只有一半的临床诊断为急性细菌性结膜炎的患者可以从结膜中分离出细菌病原体。然而，全科医生在大多数急性传染性结膜炎病例中使用抗生素。虽然该受试者从未在初级保健环境中进行过研究，但对疑似急性细菌性结膜炎的研究表明，与安慰剂相比，局部抗生素仅使5天缓解率提高了31%。1因此，在初级保健人群中，超过一半的急性传染性结膜炎患者可能接受不必要且不总是有效的抗生素治疗。这种处方政策可能会增加抗生素耐药性的风险，诱发副作用，导致医疗化和增加成本。全科医生能根据体征和症状区分病毒性结膜炎和细菌性结膜炎吗？主要的眼科教科书列出了几种体征和症状作为诊断急性传染性结膜炎的原因。一只眼睛受累，几天后另一只眼睛受累，以及耳前淋巴结肿大被认为是病毒引起的迹象。在24-48小时内另一只眼睛的参与据说表明细菌原因。乳头状或（假）膜性结膜炎提示细菌来源，而滤泡性结膜炎则提示病毒来源。粘液脓性或卡他性分泌物据说最常见于细菌性或衣原体性结膜炎，而水样分泌物被认为是更典型的病毒性结膜炎。2-4在大多数细菌性结膜炎的治疗试验中，规定的入选标准是脓性或粘液脓性分泌物和结膜充血。这些断言有何证据依据？我们计划进行一项系统性综述，以评估这些和其他体征和症状对诊断影响的证据。
In acute infectious conjunctivitis the general practitioner has to distinguish a bacterial cause from a viral one to select the patients who are most likely to benefit from antibiotic treatment. The doctor makes this distinction on the basis of the presenting signs and symptoms. Additional diagnostic investigations, such as a culture of the conjunctiva, are seldom done, mainly because the result is delayed a few days. Most treatment trials show that a bacterial pathogen can be isolated from the conjunctiva in only half of patients with clinically diagnosed acute bacterial conjunctivitis. However, general practitioners prescribe antibiotics in most cases of acute infectious conjunctivitis. Although the subject has never been investigated in a primary care setting, studies on suspected acute bacterial conjunctivitis show that topical antibiotics improve the five day remission rate by only 31% compared with placebo. 1 Therefore, in a primary care population, more than half of all patients with acute infectious conjunctivitis may receive unnecessary and not always effective antibiotic treatment. This prescription policy may increase the risk of antibiotic resistance, induce side effects, and lead to medicalisation and increases cost. Can general practitioners differentiate between viral and bacterial conjunctivitis on the basis of signs and symptoms? Major ophthalmological textbooks list several signs and symptoms as being diagnostic for the cause of acute infectious conjunctivitis. The involvement of one eye, followed a few days later by the other eye, and the presence of an enlarged preauricular node are said to be signs indicating a viral cause. The involvement of the other eye within 24-48 hours is said to indicate a bacterial cause. A papillary or (pseudo) membranous conjunctivitis is suggestive of a bacterial origin, whereas a follicular conjunctivitis is said to suggest a viral origin. A mucopurulent or catarrhal discharge is said to be most commonly seen in bacterial or chlamydial conjunctivitis, whereas watery discharge is supposed to be more typical of a viral conjunctivitis. 2–4 In most treatment trials on bacterial conjunctivitis the defined criteria for inclusion are purulent or mucopurulent discharge and conjunctival hyperaemia. How evidence based are these assertions? We planned a systematic review to assess the evidence on the diagnostic impact of these and other signs and symptoms.