Antibiotic drops for pink eye are seldom necessary, but widely prescribed

A full 60% of pink eye patients receive antibiotic drops for their condition, yet they are seldom necessary, according to recent study published in Ophthalmology.  

Furthermore, they found that 1 in every 5 antibiotic users filled prescriptions for antibiotic-corticosteroids, which are contraindicated in acute conjunctivitis. The prescribing of antibiotics seemed to be driven by sociodemographic factors as well as which type of provider initially made the diagnosis than by medical indications.

"This study opens the lid on overprescribing of antibiotics for a common eye infection," said lead study author Nakul Shekhawat, MD, MPH, resident physician, University of Michigan Kellogg Eye Center, Ann Arbor, MI.

For this retrospective, observational study, researchers included 340,372 enrollees from a large nationwide US managed care network who were newly diagnosed with conjunctivitis between 2001 and 2014. They calculated the proportion of patients who filled one or more topical antibiotic prescriptions within 14 days of initial diagnosis, and used multivariate logistic regression to determine sociodemographic, medical, and other factors associated with these prescription fills. In addition, they assessed geographic variation in prescription fills.

In all, 58% of patients filled one or more topical antibiotic prescriptions, and 38,774 filled prescriptions for antibiotic-corticosteroid combination products. African Americans (LR: 0.89, 95% CI: 0.86-0.92) and Latinos (OR: 0.83; 95% CI: 0.81-0.86) had lower odds of filling antibiotic prescriptions compared with whites.

Researchers also found that more affluent and educated patients had higher odds of filling antibiotic prescriptions compared with those who were less affluent and educated (P > 0.01 for all). Patients who were first diagnosed by an optometrist had substantially higher odds of antibiotic prescription fills compared with those initially diagnosed by an ophthalmologist (OR: 1.26; 95% CI: 1.21-1.31), and the same was true for first diagnoses by urgent care physicians (OR: 3.29; 95% CI: 3.17-3.41), internists (OR: 2.79; 95% CI: 2.69-2.90), pediatricians (OR: 2.27; 95% CI: 2.12-2.42), or family practitioners (OR: 2.46; 95% CI: 2.37-2.55).

The number of antibiotic prescriptions fills was not different in patients with risk factors for development of serious infections compared with those without these risk factors, including contact lens wearers (P=0.21) and patients with HIV or AIDS (P=0.60).

"The study shows that current treatment decisions for pinkeye are not based on evidence but are often driven more by type of health care practitioner making the diagnosis and the patient’s socioeconomic status than by medical reasons," said Dr. Shekhawat. "The potential negative consequences are difficult to justify as we move toward focusing on value in health care."

According to senior study author and Kellogg ophthalmologist Joshua Stein, MD, director of the Center for Eye Policy and Innovation, clinicians must take a new approach to managing acute conjunctivitis that involves patients, health care providers, and policymakers.

"Educating patients about acute conjunctivitis' often benign, self-limited course may help to dispel misconceptions about the condition and reduce reflexive demands for immediate antibiotic use," said Dr. Stein, who is also a member of the U-M Institute for Healthcare Policy and Innovation.

The American Academy of Ophthalmology offers guidance to clinicians on the treatment of pink eye, recommending no antibiotic treatment for viral pink eye, and the delay of immediate treatment for cases in which the cause of conjunctivitis is unknown.

Researchers received support from the W.K. Kellogg Foundation, National Eye Institute National Institutes of Health, and the American Ophthalmological Society.