Antibiotics for Viral Conjunctivitis: It's Still Happening

Antibiotic Prescription Fills for Acute Conjunctivitis Among Enrollees in a Large United States Managed Care Network

Shekhawat NS, Shtein RM, Blachley TS, Stein JD
Ophthalmology. 2017;124:1099-1107

The Misuse of Antibiotics in Acute Conjunctivitis

Most cases of acute conjunctivitis are viral in nature. Antibiotics are not effective in treating viral conjunctivitis. Despite these two well-established facts, the misuse of antibiotics in acute conjunctivitis is commonplace.

Acute conjunctivitis is one of the most frequently encountered ocular conditions in both the primary care and urgent care settings, but it is often managed incorrectly. Topical antibiotics are often prescribed for acute conjunctivitis, despite evidence suggesting that bacterial conjunctivitis is relatively uncommon in adults.

Managing acute conjunctivitis as if it were bacterial in nature also contributes to antibiotic resistance and is simply not necessary, because most cases of acute conjunctivitis are self- limited regardless of whether the etiology is viral or bacterial. Also, inappropriate prescribing of antibiotics is not harmless; besides failing to resolve the condition, it wastes millions of healthcare dollars.

Study Summary

How widespread is the practice of prescribing antibiotics for acute conjunctivitis? A recent study investigated how frequently antibiotics are prescribed for acute conjunctivitis and explored the factors that influenced the management strategy.

This retrospective investigation included nearly 350,000 enrollees in a large managed care network identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes to have a diagnosis of acute conjunctivitis. Patients with a history of recurrent or chronic conjunctivitis were excluded.

The proportion of patients who filled one or more antibiotic prescriptions was the primary outcome measure, and the type of antibiotic prescribed was also analyzed. Sociodemographic characteristics, including age, race, income, and educational status, were analyzed to identify factors that contributed to an increased likelihood of filling an antibiotic prescription.

The results of this study confirm that prescription of antibiotics for acute conjunctivitis is common among eye care providers and other healthcare providers, despite a lack of evidence to support this practice. The majority of patients were examined by healthcare providers specializing in a field other than eye care, such as internal medicine, pediatrics, family practice, and urgent care. Nearly 60% of patients filled one or more prescriptions for antibiotics—a disappointing statistic, considering that most cases of acute conjunctivitis are viral.

Perhaps even more discouraging is the number of optometrists engaging in this prescribing behavior. Forty-four percent of patients diagnosed with acute conjunctivitis by optometrists filled antibiotic prescriptions; given that these prescriptions are largely unnecessary, this statistic is sobering. Healthcare providers other than optometrists and ophthalmologists were even more likely to prescribe antibiotics. For example, 68% of patients visiting urgent care providers filled antibiotic prescriptions. Optometrists were also three times more likely than other providers to prescribe antibiotic/steroid combinations—another flawed management strategy that carries the risk for significant side effects.

The other major finding of this investigation was that likelihood of initiating antibiotic therapy was largely determined by patient socioeconomic factors, such as income and educational level, rather than by medical factors. Patients at increased risk for severe infections, such as those who wear contact lenses, those with diabetes, and those with HIV, were no more likely than other patients to begin the course of antibiotics, even though prescribing antibiotics is more defensible in these higher-risk patients.

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