Antibiotic drops for conjunctivitis in children

Emily, a three-year-old girl, was brought in by her mother with an inflamed sticky eye – infective conjunctivitis.

As I printed out a prescription for chloramphenicol 0.5% eye drops, I became aware that I had developed an idiosyncratic management procedure. If I saw pus in the eye during the consultation, I would prescribe drops, and if not, I would simply advise eye toileting and symptomatic management. Is this rational?

WHAT DOES THE RESEARCH EVIDENCE SAY?
Step 1: The Cochrane Library
There is a systematic review for antibiotics for acute bacterial conjunctivitis, but it isn’t entirely appropriate for my question – it was not limited to children and many of the participants were in a specialist rather than primary care setting.1

However, on reviewing the list of identified studies, two were conducted in primary care – one was