• Advise people with clinical features of infective conjunctivitis that:
• Most people with infective conjunctivitis get better, without treatment, within 1–2 weeks.
• For most people, use of a topical ocular antibiotic make little difference to recovery from infective conjunctivitis.
• Up to 10% of people treated with topical ocular antibiotics complain of adverse reactions to treatment.
• The risk of a serious complication from untreated infective conjunctivitis is low.
• Consider offering a topical ocular antibiotic to a person with infective conjunctivitis when:
• Infective conjunctivitis is severe, or likely to become severe, providing serious causes of a red eye can be confidently excluded.
• Schools and childcare organizations require treatment before allowing a child to return.
• They understand the limitations of treatment but still prefer treatment.
• When a topical ocular antibiotic is prescribed because of the person's preference for treatment, consider advising them to delay starting treatment for 7 days to see if the condition will resolve spontaneously without treatment.

• There are no agreed definitions of mild, moderate, or severe conjunctivitis. It would seem reasonable to consider infective conjunctivitis to be severe when the person considers the symptoms to be distressing or signs are judged to be severe from clinical experience.

These recommendations are based upon evidence from randomized controlled trials. Trials carried out in secondary care show that people with microbiologically-proven bacterial conjunctivitis benefit modestly from treatment with topical ocular antibiotics. However, the likelihood of people with clinically diagnosed infective (bacterial or viral) conjunctivitis responding to treatment is small. Based upon this evidence it seems reasonable:

• To avoid prescribing a topical ocular antibiotic for people with mild-to-moderate infective conjunctivitis where the potential benefits of treatment are limited and the risks of harms from untreated infective conjunctivitis are small:
• Advice to delay the use of antibiotics, given to people who are prescribed treatment principally because they prefer treatment, is a strategy proven to reduce antibiotic usage in primary care [Everitt et al, 2006].
• To prescribe a topical ocular antibiotic for people with more severe infective conjunctivitis because:
• They have a greater potential for benefit from treatment than people with mild-to-moderate conjunctivitis.
• They are probably at greater risk of a complication from infective conjunctivitis and it seems reasonable to try and reduce this risk.