Ann Arbor, MI—Nearly 60% of enrollees in a large U.S. managed-care network filled unnecessary antibiotic prescriptions for acute conjunctivitis, which are usually unnecessary, and nearly 20% of those filled prescriptions for antibiotic-corticosteroid compounds, which are contraindicated for the condition.
That’s according to a new study published in Ophthalmology—the first to assess antibiotic use for so-called pink eye in a large, diverse segment of the United States.
The report, led by the University of Michigan Kellogg Eye Center, suggests that most patients with acute conjunctivitis are treated incorrectly. The article emphasizes that most cases, which are usually caused by viral infections or allergies and do not respond to antibiotics, resolve without treatment within 7 to 14 days.
To determine treatment patterns, the study team reviewed data from a large managed- care network, identifying the number of patients who filled antibiotic eyedrop prescriptions for acute conjunctivitis. The characteristics of patients who got a prescription were then compared with those who did not.
Of about 300,000 patients diagnosed with acute conjunctivitis over a 14-year period ending in 2014, 58% filled a prescription for antibiotic eye drops. About a fifth of those filled a prescription for an antibiotic-steroid combination, which can prolong or exacerbate certain types of viral infection, the report notes.
Who was prescribed antibiotic eyedrops appeared to have more to do with socioeconomic status than with being at high risk for developing a more serious eye infection—as in those who wear contact lenses or have been diagnosed with HIV/AIDs, study authors point out.
The researchers indicate that patients filling antibiotic prescriptions were significantly more likely to be white, younger, better educated, and more affluent than patients who did not fill prescriptions.
The type of healthcare provider also appeared to make a difference. Study authors note that primary-care providers—family physicians, pediatricians, internal medicine physicians, and urgent-care providers—diagnose 83% of acute conjunctivitis patients, with only a small number treated by eye-care providers, such as ophthalmologists or optometrists.
That’s significant, the researchers say, because patients diagnosed by a primary-care or urgent-care provider were two to three times more likely to fill prescriptions for antibiotic eye drops than patients diagnosed by an ophthalmologist.
“This study opens the lid on overprescribing of antibiotics for a common eye infection,” explained lead author Nakul S. Shekhawat, MD, MPH. “It shows that current treatment decisions for pink eye are not based on evidence, but are often driven more by the type of health care practitioner making the diagnosis and the patient’s socioeconomic status than by medical reasons. The potential negative consequences are difficult to justify as we move toward focusing on value in health care.”
Study authors concede it is not always easy to differentiate bacterial conjunctivitis from viral and allergic forms, with all three types often presenting overlapping symptoms, such as a red eye, thin discharge, irritation, and sensitivity to light. That leads to prescribing antibiotics to “err on the side of caution,” they state.
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