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Study: Nearly 60% of acute conjunctivitis patients prescribed antibiotics
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Even though antibiotics are usually not needed to treat acute conjunctivitis, nearly 60% of patients with newly diagnosed acute conjunctivitis in a managed care network were prescribed antibiotics, according to a study.
Researchers from University of Michigan Kellogg Eye Center used the Clinformatics DataMart database to analyze records of patients in a large U.S. managed care network. The retrospective, observational cohort study included 340,372 patients with acute conjunctivitis diagnosed between Jan. 1, 2001, and Dec. 31, 2014.
Fifty-eight percent of patients in the study filled one or more topical antibiotic prescriptions for acute conjunctivitis. Those first diagnosed by an ophthalmologist had the lowest percentage of filled antibiotic prescriptions (36%) while those diagnosed by an urgent care physician had the highest percentage (68%).
Enrollees diagnosed by an optometrist, internist, pediatrician or family practitioner all had higher odds to fill an antibiotic prescription for conjunctivitis.
Black patients had 11% lower odds than white patients of filling prescriptions, Latino patients had 17% lower odds, and Asian-Americans had 27% lower odds.
Patients with higher education and affluence had higher odds of filling prescriptions compared with those with lower education and affluence (P < .01).
“Patterns of antibiotic use for acute conjunctivitis seem to be driven more by sociodemographic factors and the type of health care provider who diagnosed the condition than by medical indications. These findings highlight the need to educate patients, clinicians and health policy makers better about acute conjunctivitis and to search for ways to reduce unnecessary use of antibiotics for this condition,” the researchers wrote. – by Robert Linnehan
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Penny A. Asbell, MD, FACS, MBA, FARVO
Clearly prescribing topical antibiotics for non-bacterial causes of conjunctivitis is a waste of resources and an inappropriate use of antibiotics; antibiotic resistance is of concern to all health care providers and short-term use of topical antibiotics may contribute to this problem. However, to state that acute conjunctivitis is a “self-limiting” disease and therefore does not have to be treated belies the fact that one-third of ocular emergency room visits are for conjunctivitis. It is one of the most common ocular complaints for general practice visits combined with the recent report that found in their review over 50% started treatment; we therefore can assume that each patient felt it was important to resolve the symptoms, whether for quality of life, work, school and/or cosmesis needs. The data suggest what is needed is accurate, quick point of care tests to determine the cause of the conjunctivitis and treatments that are efficacious and safe to use. Though use of topical steroids can lead to adverse events, many infectious diseases do require anti-inflammatory treatment for faster and more complete resolution. This too needs study in regard to conjunctivitis to determine the risk/benefit ratio and if and when to use. Conjunctivitis is common and does “eat up” medical resources; evidence-based information may lead the way to improved and better care.
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Shekhawat NS, et al. Ophthalmology. 2017;doi:10.1016/j.ophtha.2017.04.034
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