Clinicians Overprescribing Antibiotics for Common Eye Infection

A study published in Ophthalmology found that nearly 60% of patients diagnosed with acute conjunctivitis, or pink eye, were prescribed antibiotics even though treatment with these agents is rarely necessary. 

To evaluate how frequently patients with new-onset acute conjunctivitis filled prescriptions for topical antibiotics, study authors from the University of Michigan conducted a retrospective, observational cohort study (n=340,372) using data from a large managed care network (2001–2014).

The authors looked at the proportion of patients newly diagnosed with acute conjunctivitis who filled one or more topical antibiotic prescription within 14 days of initial diagnosis. Sociodemographic, medical, geographic variation, and other factors associated with antibiotic fills for acute conjunctivitis were also evaluated. 

Fifty-eight percent (n=198,462) of the total patients had filled ≥1 topical antibiotic prescription, of which approximately 20% (n=38,774) of patients filled prescriptions for combination antibiotic + corticosteroid products. Black (OR 0.89) and Latino (OR 0.83) patients were less likely to fill a prescription compared to white patients. Patients who were more affluent and educated demonstrated a higher likelihood of filling antibiotics (P<0.01 for both) compared to those who were less affluent and educated.  

The data also found considerably higher odds of antibiotic prescription fills if the acute conjunctivitis was first diagnosed by an optometrist (OR 1.26, 95% CI: 1.21–1.31), an urgent care physician (OR 3.29, 95% CI: 3.17–3.41), an internist (OR 2.79, 95% CI: 2.69–2.90), a pediatrician (OR 2.27, 95% CI: 2.13–2.43), or family practitioner (OR 2.46, 95% CI: 2.37–2.55), as compared to ophthalmologists. 

Prescription fills were found to be similar among patients with risk factors for developing serious infection (ie, contact lens wearers, HIV/AIDS patients) and those without risk factors.

Sociodemographic factors and the type of clinician doing the diagnosing seem to influence whether a patient fills an antibiotic prescription for acute conjunctivitis more so than the medical indication. The findings further validate the trend of overprescribing antibiotics for common viral or mild bacterial infections. One reason for possible antibiotic misuse may be due to the difficulty in differentiating bacterial, viral, and allergic forms of conjunctivitis. Also, clinicians may choose to prescribe antibiotics “just in case.” 

Lead author, Nakul S. Shekhawat, MD, MPH, stated, “These potentially harmful practices may prolong infection duration, may promote antibiotic resistance, and increase costs.” 

For more information visit aaojournal.org.