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Can Fam Physician. 2009 Nov;55(11):1071-5.

Evidence-based treatment of acute infective conjunctivitis: Breaking the cycle of antibiotic prescribing.

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Office of Health Professions Student Affairs, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2171B, Toronto, ON M5S 1A8.



To discover the best treatments for acute infective conjunctivitis and to discern whether antibiotics are necessary for the resolution of bacterial conjunctivitis in particular.


MEDLINE, EMBASE, and the Cochrane Database of Systematic reviews were searched. Findings were limited to full-text articles from core clinical journals in the English language, and are based on level I or level II evidence. Clinical Evidence was also searched, from which moderate-quality results have been cited.


Infective conjunctivitis should be managed conservatively, with antibiotics prescribed either after a delayed period if symptoms do not improve within 3 days of onset, or not at all. This approach helps to prevent the medicalization of the condition (reducing consultations for future occurrences) and discourages the unnecessary use of antibiotics, which might delay diagnosis of other serious red eye conditions. Physicians and patients should be educated on the self-limiting nature of the condition to increase compliance with conservative treatment and change the management expectations of parents and schools.


Acute infective conjunctivitis is the most common ocular complaint dealt with in family practice; its viral and bacterial etiologies are difficult to distinguish on clinical grounds alone. Evidence suggests that properly educating patients with written information materials is the most effective way to manage this simple ailment and increase patient satisfaction.

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