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Reference - MMWR Recomm Rep 2010 Dec 17;59(RR-12):1 , correction can be found in MMWR 2011 Jan 14;60(01):18 oral erythromycin in first 2 weeks of life associated with 8 times increased risk for infantile hypertrophic pyloric stenosis (level 2 [mid-level] evidence) o based on retrospective cohort study o 314,029 infants followed for first 90 days of life, 7,138 (2.3%) were prescribed oral erythromycin, 804 (0.26%) developed pyloric stenosis o exposure to oral erythromycin on days 3-13 of life associated with nearly 7.88 times increased risk (95% CI 1.97-31.57) o no increase in risk for erythromycin given after age 14 days o no increase in risk with other antibiotics o Reference - Arch Pediatr Adolesc Med 2002 Jul;156(7):647 oral azithromycin and doxycycline appear to have similar efficacy for chlamydial conjunctivitis (level 2 [mid-level] evidence) o based on randomized trial with high dropout rate and without blinding o 78 adults with inclusion conjunctivitis due to Chlamydia trachomatis randomized to doxycycline 100 mg orally twice daily for 10 days vs. azithromycin 1 g orally once o only 51 (65%) completed the study o no significant differences in rates of clinical cure (69% vs. 60%) or microbiologic cure (96% vs. 92%) o study too small to rule out clinical differences o Reference - Am J Ophthalmol 2003 Apr 1;135(4):447
Anti-inflammatory drugs:
ketorolac eye drops do not appear effective for viral conjunctivitis (level 2 [mid-level] evidence) o based on randomized trial with allocation concealment not stated o 117 patients with viral conjunctivitis randomized to ketorolac 0.5% (Acular) vs. artificial tears (Moisture Drops) 1 drop 4 times daily for 7 days o 105 returned for follow-up at 3-4 days o no significant differences in outcomes except artificial tear groups reported more improvement in redness o 59% ketorolac vs. 19% control group reported stinging (p < 0.001, NNH 2) o Reference - Ophthalmology 2000 Aug;107(8):1512
topical dexamethasone may not reduce symptoms of viral conjunctivitis compared to placebo (level 2 [mid-level] evidence) o based on randomized trial with high dropout rate and inadequate statistical power o 111 patients with acute follicular conjunctivitis presumed viral in origin randomized to dexamethasone 0.1% drops vs. hypromellose 0.3% drops 4 times/day for 1 week o 21% dropped out and excluded from analyses o no significant differences between groups in patient level of discomfort or conjunctival hyperemia