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Conjunctivitis Is Delayed Treatment an Option?

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 conjunctivitis.

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 option.

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.

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