Antibiotics for Viral Conjunctivitis: It's Still Happening

Brianne N. Hobbs, OD


September 20, 2017


Despite a major campaign by the American Academy of Ophthalmology to eliminate the practice of routinely prescribing antibiotics for acute conjunctivitis, it is evident that this practice persists among both eye care providers and other healthcare providers.

It is noteworthy that 83% of patients with acute conjunctivitis in this study were managed by a healthcare provider other than an optometrist or ophthalmologist, indicating the need for widespread clinical education on the management of acute conjunctivitis to all healthcare providers.

Fluoroquinolones were the most commonly prescribed antibiotic in this study; unfortunately, they are also some of the most expensive antibiotics available and have been associated with increased colonization of the ocular surface by methicillin-resistant Staphylococcus aureus.[1] Prescribing these "big gun" fluoroquinolones for mild conjunctivitis—which poses no threat to vision—is ill-advised because it may render these antibiotics less effective for more serious ocular conditions.

This study was significant because it established that the actual prescribing behavior of clinicians differs dramatically from evidence-based guidelines. What factors are responsible for this deviation? Clinicians certainly receive pressure from some patients to prescribe antibiotics. Policies by schools, day care centers, employers, and even state health departments contribute to the problem by requiring antibiotics to return to school or work. Targeted education to these community policy-makers would help eliminate these inappropriate policies and reduce the pressure that clinicians face to prescribe antibiotics.

In addition, more studies such as this one are needed to understand the scope of improper antibiotic prescribing and to identify strategies to remedy this pervasive problem.


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