## 4 Discussion  
Although acute bacterial conjunctivitis is known as a common medical condition worldwide, there is a lack of population-based incidence studies, which leads to inaccurate data regarding its true epidemiology [26; 27]. First, there is a clinical ambiguity among infectious and non-infectious conjunctivitis, and between acute viral and bacterial conjunctivitis [26]. Because a high number of patients self-medicate or delay or decline to seek medical care, and inaccurate diagnosis in the primary medical care setting is frequent [27]. \begin{table}
\begin{tabular}{c c} \hline \hline  & **Patients (6583)** \\ \hline \multicolumn{3}{c}{_Classes of topical treatment_} \\ Antibiotics + Corticosteroids n (\%) & 4487 (68.2) \\ Antibiotics + NSAIDs n (\%) & 2368 (36) \\ Antibiotics + NSAIDs + Corticosteroids n (\%) & 1148 (17.4) \\ \multicolumn{3}{c}{_Specific topical treatments_} \\ Gentamycin (Oftalmolosa Cusi Gentamicina) n (\%) & 613 (9.3) \\ Tobramycin (Tobrex) n (\%) & 4631 (70.3) \\ Tobramycin and Dexamethasone & (Tobradec) n (\%) & 3513 (53.4) \\ Neomycin (Maxitrol) n (\%) & 212 (3.2) \\ Tobramycin (Terracortril) n (\%) & 373 (5.7) \\ Corticosteroids n (\%) & 4855 (73.8) \\ Dexamethasone (Colricusi Dexamethasone+) n (\%) & 3965 (60.2) \\ Hydrocortisone (Oftalmolosa Cusi Hydrocortisone+) n (\%) & 657 (10) \\ Fluorometholome (Isopto Flucon) n (\%) & 801 (12.2) \\ \hline \hline \end{tabular}
\end{table} 
Table 4: Topical medications used for treating acute bacterial conjunctivitis. \begin{table}
\begin{tabular}{c c} \hline \hline  & **Patients (6583)** \\ \hline \multicolumn{3}{c}{Conjunctival hyperemia n (\%)} & 4908 (74.6) \\ \multicolumn{3}{c}{Conjunctival discharge n (\%)} & 618 (9.4) \\ \multicolumn{3}{c}{Bulbar conjunctival injection n (\%)} & 105 (1.6) \\ \multicolumn{3}{c}{Ocular pain n (\%)} & 731 (11.1) \\ \multicolumn{3}{c}{Chemosis n (\%)} & 500 (7.6) \\ \multicolumn{3}{c}{Foreign body sensation n (\%)} & 643 (9.8) \\ \multicolumn{3}{c}{Tearing n (\%)} & 1367 (20.8) \\ \multicolumn{3}{c}{Ocular itching n (\%)} & 2809 (42.7) \\ \multicolumn{3}{c}{Photophobia n (\%)} & 232 (3.5) \\ \multicolumn{3}{c}{Corneal ulcer n (\%)} & 180 (2.7) \\ \hline \hline \end{tabular}
\end{table} 
Table 3: Signs and symptoms in patients with acute bacterial conjunctivitis. In the present patient series, 29% of the cases were detected in the emergency department of the participating hospitals, and only 5.7% of the patients presented more than one episode. Despite acute bacterial conjunctivitis (ABC) is a common medical condition, the current study showed that the number of patients with acute conjunctivitis treated with topical antibiotics was relatively low over five years. This low frequency depends on two main reasons. First, the study concerned in-hospital patients. Second, patients with acute conjunctivitis usually refer to the practitioner or pharmacist but rarely to the ophthalmologist or emergency room, except for the severe presentation. The present study provided a series of interesting outcomes that may reflect what happens in the daily hospital practice. Patients managed by A&E doctors are more than patients visited by ophthalmologists. It could depend on clinical severity and prompt availability of A&E physicians. Moreover, acute conjunctivitis may also occur during hospitalization in every specialistic unit. The relatively old age (54.8 years) probably depends on the global population, including inpatients; consistently, comorbidity frequencies were typical for the mean age. Notably, antibiotics were always used in patients with suspected acute bacterial conjunctivitis, even if the prescription was performed on a clinical ground in the vast majority of patients (about 90%). Microbiology was tested only in 12.1% of patients, likely the most severe, as the percentage of positive cultures was dramatically high (near 100%). Gram-negative bacteria were very frequent (37%); _S pneumoniae_ and _S aureus_ were prevalent, probably by self-contamination.