Doctors of optometry less likely to prescribe “seldom needed” antibiotics for conjunctivitis

The overprescribing of antibiotics in cases of conjunctivitis, known also as pink eye, is potentially harmful, a new study says.

Published online in Ophthalmology in June 2017, the study was conducted by researchers at the University of Michigan and looked at patients in a large nationwide managed care network. Of the patients enrolled in the network, 340,372 were diagnosed with acute conjunctivitis between 2001 and 2014.

While 58% of those had filled at least one prescription for topical antibiotics within 14 days of their diagnoses, the study's authors found, though that treatment is "seldom necessary." Typically, the authors say, most cases of pink eye do not respond to topical antibiotics.

"Nearly 60% of enrollees in this managed care network filled antibiotic prescriptions for acute conjunctivitis, and 1 of every 5 antibiotics users filled prescriptions for antibiotic-corticosteroids, which are contraindicated for acute conjunctivitis," the study says.

"These potentially harmful practices may prolong infection duration, may promote antibiotic resistance, and increase costs," it adds.

Other key findings of the study's authors:

• 83% of those initial diagnoses were made by non-eye doctors-family practice physicians, internal medicine physicians, pediatricians, urgent care physician or other health care provider. They were also more likely two to three-fold higher odds to prescribe antibiotics than eye doctors.
• Sociodemographic factors such as age, race, income and education influence when prescriptions were written.
• "Societal demands" may also be a factor in prescribing antibiotics, as some state health departments encourage or require children and adults get antibiotics for the contagious eye condition before they can return to work and classrooms.
  

Different strokes

The study's authors cite several reasons for the overprescribing, rather than the condition running its course typically up to two weeks. Differentiating between viral, allergic and bacterial cases of conjunctivitis can be challenging; others may lack the knowledge on managing the inflammation of the thin, transparent tissue layer that lines the inner surface of the eyelid and covering of the white part of the eye.

Mary Gregory, O.D., who practices in Monticello, Minnesota, rarely prescribes antibiotics for pink eye at Uptown Eye Care.

"I have a primarily pediatric practice and write less than 15 prescriptions for conjunctivitis a year," Dr. Gregory says. "Studies showing that antibiotics are not necessary and are detrimental, in most cases, are important. However, most practicing optometrists have known this for years.

"In 15 years, I have not had any issues with children being able to return to school or daycare," adds Gregory who prefers to prescribe artificial tears to relieve patients' discomfort.

Rather than prescribe antibiotics, Dr. Gregory takes another tact-education. The numbers of pink eye tend to pick up in the fall and early winter at her practice when school starts and children are more often indoors and in closer quarters.

Until the pink eye inflammation goes away, Dr. Gregory offered prevention tips for children and adults:

• Wash your hands frequently and use your own towel.
• Change your pillowcase nightly.
• Wash daily stuffed animals and toys that are shared and blankets carried around for comforting. "Doing these, along with the artificial tears, will help their eyes look and feel better," Dr. Gregory says.

She also reaches out to school nurses.

"I talk to the nurses regarding the viral nature of most conjunctivitis and how it's similar to the contagiousness of a cold," Dr. Gregory says. "They then can talk to the kids about hygiene. If they don't keep children home with a cold, they shouldn't keep them home with viral conjunctivitis.

"I would encourage all optometrists to talk to school nurses," she says. "Many times, the local school nurses are very open to education and information you can provide."