Topical antibiotics may be overprescribed in children with conjunctivitis
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Key takeaways:
- Topical antibiotics were dispensed within 1 day of 69% of ambulatory encounters.
- Recurring conjunctivitis was rare regardless of antibiotic initiation timing.
Overtreating acute conjunctivitis with topical antibiotics may contribute to antibiotic resistance with no improvement in outcomes, according to a research letter published in JAMA Ophthalmology.
“Although the American Academy of Ophthalmology suggests that foregoing immediate topical antibiotic treatment is safe and effective in most circumstances, antibiotics are frequently prescribed,” Daniel J. Shapiro, MD, MPH, assistant professor of emergency medicine at the University of California, San Francisco, and pediatric emergency care physician at UCSF Benioff Children’s Hospitals, and colleagues wrote.
In a cohort study using the 2021 MarketScan Commercial Claims and Encounters Database, researchers identified children aged 1 to 17 years who had ambulatory care encounters and a diagnosis of conjunctivitis to determine the frequency of topical antibiotic treatment and subsequent care in pediatric patients.
The researchers evaluated 44,793 ambulatory care encounters, which included 21,210 girls and 23,583 boys (median age, 5 years).
In 69% of the encounters, topical antibiotics were dispensed within 1 day. However, topical antibiotics were less likely to be dispensed after visits to eye clinics (34%), in children aged 6 to 11 years (66%) and in children with viral conjunctivitis (28%).
Revisits for conjunctivitis within 14 days “were rare,” researchers wrote, occurring after only 3.2% of initial encounters. Similarly, same-day antibiotic dispensation for all-cause revisits occurred after just 1.4% of initial encounters.
After adjusting for characteristics of the children, visits and clinicians, researchers reported that treatment with topical antibiotics was not linked to revisits for conjunctivitis or with same-day dispensation of antibiotics.
“Given that antibiotics may not be associated with improved outcomes or change in subsequent health care use and are associated with adverse effects and antibiotic resistance, efforts to reduce overtreatment of acute infectious conjunctivitis are warranted,” Shapiro and colleagues wrote.
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Shapiro DJ, et al. JAMA Ophthalmol. 2024;doi:10.1001/jamaophthalmol.2024.2211.
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