Clinical Question #5: In children
greater than 8 weeks with suspected bacterial conjunctivitis, is
delayed treatment a valid option?
We RECOMMEND based on low quality
evidence consideration for delayed treatment or delayed
prescription option for patients with suspected bacterial
Rationale and Evidence Base
Everitt et al published a randomized controlled trial on the
management strategies for treatment of acute infective
conjunctivitis comparing immediate antibiotic prescriptions on
initial presentation to a provider, delayed prescription for three
days and no prescription in the British Medical Journal in
2006. The authors advocate for a delayed prescribing strategy for
treatment of acute conjunctivitis in the primary care setting
identifying that delayed prescribing had an almost 50% reduction in
antibiotic use with patients experiencing similar symptom control
and fewer second visits to providers for continued symptoms
(Everitt, Little et al. 2006). The overall self limiting nature of
conjunctivitis in addition to the difficulty in determining viral
or bacterial etiologies makes delayed prescribing a viable
These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time.
It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.