Intervention reduces antibiotic use for pediatric conjunctivitis
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Key takeaways:
- Guidelines recommend against prescribing antibiotics to treat pink eye except in certain circumstances.
- An intervention significantly reduced antibiotic use for conjunctivitis in the Denver Health system.
An intervention undertaken by dozens of health centers reduced antibiotic use for pediatric conjunctivitis by up to 19% without increasing treatment failure, according to study findings.
“Conjunctivitis, also sometimes referred to as pink eye, is one of the most common reasons that children come into the doctor's office,” Holly M. Frost, MD, senior director of the Center for Health Systems Research at Denver Health, told Healio. “It’s also a really common reason that kids are excluded from day care and school. So, it has a big impact on many of the families that we care for.”
Frost said one of the study’s goals was making sure the care being provided for conjunctivitis aligned with national guidelines, which recommend against using antibiotics, eye drops or ointment to treat pink eye except in certain circumstances.
“We know that most kids who have conjunctivitis will get better on their own,” Frost said. “What we previously found is that despite that recommendation, about 73% of kids are prescribed an antibiotic eye dropper ointment to use with regular conjunctivitis. The goal of this project was really to reduce unnecessary antibiotic use.”
Frost and colleagues implemented a quality improvement intervention for pink eye at Denver Health’s 32 health care clinics, three urgent care centers, a pediatric ED and the Denver public school district. They created a critical care guideline for all the clinicians at the study-involved institutions to use, which updated policies for nurses to ensure they were not prescribing unnecessary antibiotics. They also created materials for parent and clinician education.
Additionally, “We created some tools within the electronic health record in order to make care for conjunctivitis easier, and then we looked at the effectiveness of that intervention over three different time periods,” Frost said.
These time periods were labeled the pre-COVID-19 preintervention period, which ran from November 2018 to February 2020; the COVID-19 preintervention period, which ran from March 2020 to March 2021; and the postintervention period, which began in April 2021 and ran until December 2022.
Out of 6,960 eligible encounters, the authors found an 18.8% reduction in ophthalmic antibiotic use from the COVID-19 preintervention period to the postintervention period, a 16.1% reduction during the preintervention period following the onset of COVID-19 and an 82.1% reduction in prescribing rates for nurse triage encounters.
“The interventions also reduce inequities in conjunctivitis care for kids,” Frost said. “We found, for example, [that] between children who are Black and children who are white, the inequity reduced to less than 1%. We similarly found reduction in inequities between kids who were Latino and kids who were not Latino. So, we kind of saw that, in general, it helps with standardized care, and to make the care that we're providing for conjunctivitis more equitable.”
Treatment failure occurred in 18.7% of children overall and was more common among children who received antibiotics (20%) than those who did not (17.9%), the researchers reported.
“It’s important for people to recognize that conjunctivitis is a big deal for kids and [their] families, and that it is important to make sure that we're providing guideline-concordant care for this condition,” Frost said. “While it may not seem like a big deal for clinicians in the office, we know that has a tremendous impact on health care utilization, and exclusion from day care and school for kids.”
Perspective
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Annabelle De St. Maurice, MD, MPH
This study echoes a lot of what we already know about pediatric conjunctivitis, which is that antibiotics are overprescribed. What was encouraging to hear is that this health system was able to really make changes to prescribing practices over time using a low-cost, multipronged approach to reduce unnecessary antibiotic use. A lot of providers know that antibiotic treatment for conjunctivitis is unnecessary, but sometimes it's difficult to implement changes in your practice.
Most conjunctivitis doesn't need antibiotics and will get better over time with supportive care. Sometimes providers may feel pressured to prescribe antibiotics, but through different interventions, we can reduce antibiotic use.
Parents should also have an understanding and expectation that if their child has conjunctivitis, they don't necessarily need antibiotic drops.
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