Sheikh A and Hurwitz B. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database of Systematic Reviews 2006. Issue 2. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001211/frame.html Accessed 23.09.14. RATIONALE: Meta-analysis of five RCTs (n = 1034) found that antibiotics (one trial each of ocular polymixin plus bacitracin, ciprofloxacin, norfloxacin, fusidic acid, and chloramphenicol) improve early clinical remission rates (Risk Ratio on days 2 to 5 1.24, 95% CI 1.05 to 1.45). Clinical remission rates compared with placebo are lower if remission is assessed later (Risk Ratio on days 6 to 10 1.11, 95% CI 1.02 to 1.21).

American Academy of Ophthalmology Corneal/External Disease Panel. Preferred Practice Pattern Guidelines. Conjunctivitis. American Academy of Ophthalmology. 2008. Diagnosis: this guideline contains a useful table of signs and symptoms for all causes of conjunctivitis.

ABPI Medicines Compendium. Summary of product characteristics for Fucithalmic. 1997. Datapharm Communications Ltd. http://www.medicines.org.uk/EMC/searchresults.aspx?term=Fucithalmic&searchtype=QuickSearch Accessed 23.09.14. RATIONALE: Fucithalmic is active against a wide range of Gram positive organisms, particularly Staphylococcus aureus. Other species against which Fucithalmic has been shown to have in vitro activity include Streptococcus, Neisseria, Haemophilus, Moraxella and Corynebacteria.

Rose PW, Harnden A, Brueggemann AB, Perera R, Sheikh A, Crook D, Mant D. Chloramphenicol treatment for acute infective conjunctivitis in children in primary care: a randomised double-blind placebo-controlled trial. Lancet 2005; 366: 37-43. RATIONALE:This study (n = 326) found that most children presenting with acute infective conjunctivitis in primary care will get better by themselves, and there is no statistically significant difference between using placebo or chloramphenicol. Clinical cure by day 7 occurred in 83% of children given placebo compared with 86% of children given chloramphenicol. Risk difference 3.8%, 95% CI -4.1% to 11.8%.

Reitveld RP, ter Riet G, Bindels PJ, Bink D, Sloos JH, van Weert HC. The treatment of acute infectious conjunctivitis with fusidic acid: a randomised controlled trial. Br J Gen Pract 2005;55:924-930. RATIONALE: This primary care-based study (n = 163) found no statistically significant difference in clinical cure rates at 7 days in people using fusidic acid (62%) compared with placebo (59%). Adjusted risk difference 5.3%, 95% CI -11% to 18%.

Walker S, Daiper CJ, Bowman R, Sweeney G, Seal DV, Kirkness CM. Lack of evidence for systemic toxicity following topical chloramphenicol use. Eye 1998;12: 875-879. RATIONALE: Despite widespread prescribing of topical chloramphenicol, the incidence of aplastic anaemia in the UK remains low, and epidemiological data do not suggest an association between aplastic anaemia and topical chloramphenicol. Furthermore, a study of chloramphenicol levels in 40 patients found that chloramphenicol failed to accumulate to detectable levels in serum following one and two weeks of topical treatment.

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).