Managing conjunctivitis in nurseries and other childcare facilities

Research published in September 2016 in the British Journal of General Practice found that many childcare providers require children with infectious conjunctivitis to be treated with antibiotics before they can be readmitted to nursery, despite current government guidance from PHE which states that exclusion is not necessary.

The study looked at policies from 164 childcare providers across the UK and found that around half of them required children to be treated with antibiotics before they were allowed to return to nursery, while the remainder of providers’ policies were in line with the guidance with no requirement to treat before returning to nursery.

Such policies mean that parents are under pressure to obtain antibiotics in order to get their child re-admitted and GPs are under pressure to prescribe.

It is understandable that childcare providers have concerns in admitting children with conjunctivitis as they don’t want to put other children at risk, but policies that require children to have taken antibiotics before being re-admitted are not in line with official clinical guidelines and have some serious implications.

Antibiotics are not effective against viral or allergic conjunctivitis. Bacterial conjunctivitis usually resolves on its own in most cases. Use of antibiotic eye drops has only a modest effect on the length of symptoms caused by bacterial conjunctivitis; one study reported that chloramphenicol eye drops shortened duration of symptoms by 0.3 days.

Antibiotics are life-saving drugs when used appropriately but over-use for conditions where there is no evidence of clinical benefit encourages the bacteria to become resistant to the drugs, meaning that over time the drugs become useless. Already some bacteria are very difficult to treat and the problem is increasing. GPs and other healthcare professionals are working hard to conserve antibiotics so that they remain effective.

 What can I do?

Childcare providers

  • should check current policies around control of infectious disease against the PHE guidance document
  • should not require children to be treated with antibiotics before returning to nursery
  • are recommended not to exclude children with symptoms of conjunctivitis


  • should allow symptoms to resolve before seeking antibiotics from their GP or purchasing antibiotic eye drops from pharmacy. For more information see NHS Choices


Conjunctivitis can be caused by bacteria, viruses, allergic reactions or sensitivity to environmental triggers like smoke, exhaust fumes, perfumes or other chemicals.

Antibiotic eye-drops are not available over the counter for children aged less than two years

Original Study: Samuel Finnikin, Kate Jolly. Br J Gen Pract Sep 2016, 66 (650) e674-e679; DOI: 10.3399/bjgp16X686125

More information about preventing antibiotic resistance is available at


Dr. Jo Jefferies BSc PhD FFPH

Consultant in Public Health,

Berkshire Shared Public Health Team