Home' Australian Pharmacist : Australian Pharmacist September 2014 Contents Australian Pharmacist September 2014 I © Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
EVIDENCE IN PATIENT CARE
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Australian Pharmacist Continuing Professional
Development (CPD) is a central element of PSA’s
CPD & PI program. It is also part of the New
Zealand College of Pharmacists (NZCP) education
program for NZ pharmacists.
The CPD section is recognised under the PSA
CPD & PI program as a Group 2 activity. Members
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CPD credits are allocated based on the length of
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presented. A minimum of 6 out of 8 questions,
4 out of 5 questions, or 3 out of 4 questions
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1. Which of the following statements
about conjunctivitis is FALSE?
a) It can be caused by allergy.
b) It is often misdiagnosed.
c) It can be caused by irritants.
d) Most cases are due to bacterial
2. Infective conjunctivitis in adults is
MOST often due to:
b) H. influenzae.
c) S. pneumonia.
d) N. gonorrhoeae.
3. Which of the following symptoms
is the BEST indication of bacterial
a) Profuse watery discharge.
b) Red eye with foreign body sensation.
c) Bilateral glued eyes.
d) Mild to moderate purulent discharge.
4. Which of the following is generally
the MOST appropriate management
strategy for suspected bacterial
a) Ciprofloxacin eye drops.
b) Propamidine eye drops.
c) Provide reassurance, delay topical antibiotic
use and provide supportive care.
d) Framycetin eye drops.
5. Which of the following factors does
NOT necessarily warrant referral to a
GP, emergency department doctor,
or optometrist by the pharmacist?
a) Significant eye pain.
b) Impaired vision.
d) Age over 65 years.
Approximately 1–2% of primary care
consultations are conjunctivitis-related,
and the condition is associated with
significant costs. Pharmacists need to be
aware that relying on signs and symptoms
often leads to an inaccurate diagnosis,
and so the focus should be on ruling out
more serious conditions and referring
If acute bacterial conjunctivitis is suspected,
and there are no serious signs or symptoms,
supportive care with or without delayed or
immediate topical antibiotic therapy are all
A shared-care approach is appropriate,
with patients made aware of the self-
limiting nature of the condition and the
marginal benefits of antibiotic therapy.
1. Visscher KL, Hutnik CM, Thomas M. Evidence-based treatment
of acute infective conjunctivitis: Breaking the cycle of antibiotic
prescribing. Can Fam Physician 2009;55:1071–5 .
2. Shields T, Sloane PD. A comparison of eye problems in primary
care and ophthalmology practices. Fam Med 1991;23:544–6.
3. Smith AF, Waycaster C. Estimate of the direct and indirect
annual cost of bacterial conjunctivitis in the united states. BMC
4. Azari AA, Barney NP. Conjunctivitis: A systematic review of
diagnosis and treatment. JAMA 2013;310:1721–9.
5. Rosario N, Bielory L. Epidemiology of allergic conjunctivitis. Curr
Opin Allergy Clin Immunol 2011;11:471–6.
6. O’Brien TP, Jeng BH, McDonald M, et al. Acute conjunctivitis:
Truth and misconceptions. Curr Med Res Opin 2009;25:1953–61.
7. Cronau H, Kankanala RR, Mauger T. Diagnosis and management
of red eye in primary care. Am Fam Physician 2010;81:137–44.
8. Statham MO, Sharma A, Pane AR. Misdiagnosis of acute eye
diseases by primar y health care providers: Incidence and
implications. Med J Aust 2008;189:402–4 .
9. Durkin SR, Casey TM. Beware of the unilateral red eye: Don’t miss
blinding uveitis. Med J Aust 2005;182:296–7.
10. Tarabishy AB, Jeng BH. Bacterial conjunctivitis: A review for
internists. Cleve Clin J Med 2008;75:507–12.
11. Rietveld RP, van Weert HC, ter Riet G, et al. Diagnostic impact
of signs and symptoms in acute infectious conjunctivitis:
Systematic literature search. BMJ 2003;327:789.
12. Rietveld RP, ter Riet G, Bindels PJ, et al. Predicting bacterial cause
in infectious conjunctivitis: Cohort study on informativeness of
combinations of signs and symptoms. BMJ 2004;329:206–10.
13. Kaufman HE. Adenovirus advances: New diagnostic and
therapeutic options. Curr Opin Ophthalmol 2011;22:290–3 .
14. Azar MJ, Dhaliwal DK, Bower KS, et al. Possible consequences
of shaking hands with your patients with epidemic
keratoconjunctivitis. Am J Ophthalmol 1996;121:711–2.
15. Uchio E, Takeuchi S, Itoh N, et al. Clinical and epidemiological
features of acute follicular conjunctivitis with special reference
to that caused by herpes simplex virus type 1. Br J Ophthalmol
16. Fitch CP, Rapoza PA, Owens S, et al. Epidemiology and
diagnosis of acute conjunctivitis at an inner-city hospital.
17. Hovding G. Acute bacterial conjunctivitis. Acta Ophthalmol
18. Sheikh A, Hurwitz B, van Schayck CP, et al. Antibiotics versus
placebo for acute bacterial conjunctivitis. Cochrane Database
Syst Rev 2012;9:CD001211.
19. Everitt HA, Little PS, Smith PW. A randomised controlled trial
of management strategies for acute infective conjunctivitis in
general practice. BMJ 2006;333:321.
20. Block SL, Hedrick J, Tyler R, et al. Increasing bacterial resistance
in pediatric acute conjunctivitis (1997-1998). Antimicrob
Agents Chemother 2000;44:1650–4.
21. Sheikh A, Hurwitz B. Topical antibiotics for acute bacterial
conjunctivitis: Cochrane systematic review and meta-analysis
update. Br J Gen Pract 2005;55:962–4 .
22. Rose PW, Harnden A, Brueggemann AB, et al. Chloramphenicol
treatment for acute infective conjunctivitis in children in
primary care: A randomised double-blind placebo-controlled
trial. Lancet 2005;366:37–43.
23. Therapeutic Guidelines. ETG complete: Antibiotic 2014.
24. Rose PW, Ziebland S, Harnden A, et al. Why do general
practitioners prescribe antibiotics for acute infective
conjunctivitis in children? Qualitative interviews with gps and
a questionnaire survey of parents and teachers. Fam Pract
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