Ophthalmologists have stated that many children and adults with conjunctivitis are being treated incorrectly.
New research by ophthalmologists at the University of Michigan Kellogg Eye Centre has found that conjunctivitis, a common condition that keeps many children out of crèche and school, is being over-treated with antibiotic eye drops.
The HSE state that infective conjunctivitis is responsible for 35 percent of all eye-related problems recorded in GP surgeries, with 13-14 cases for every 1,000 people each year in Ireland.
There are three types: viral, bacterial and allergic conjunctivitis. Most cases are caused by viral infections or allergies and do not respond to antibiotics. Artificial tears and warm compresses may help keep the eye comfortable while viral conjunctivitis runs its course. Antibiotics are often unnecessary for bacterial conjunctivitis because most cases are mild and would resolve on their own within seven to 14 days without treatment.
Dr Nakul Shekhawat, warns that the largely unnecessary prescribing of antibiotic-steroid eye drops is consistent with a global trend of antibiotic misuse for common viral and mild bacterial conditions. Dr Shekhawat says that it’s a trend that increases costs to patients and the health care system, and may further promote antibiotic resistance.
Currently, about 60 percent of patients are prescribed antibiotic eye drops, even though antibiotics are rarely necessary to treat this common eye infection. Of those filling antibiotic prescriptions, 20 percent handed over prescriptions for antibiotic-steroid eye drops that can prolong or worsen the infection.
Shekhawat and his colleagues used data from a large care network in the US, in order to identify the number of patients who filled antibiotic eye drop prescriptions for acute conjunctivitis. They then evaluated the characteristics of patients who filled prescriptions compared to those who did not. The team found that, among 340,372 people diagnosed with acute conjunctivitis over a 14-year period, 58 percent filled a prescription for antibiotic eye drops.
The study found that most patients were diagnosed by non-specialists (such as a GP or paediatrician), with only a minority diagnosed by eye care specialists such as ophthalmologists or optometrists. Those diagnosed by a GP were two to three times more likely to fill prescriptions for antibiotic eye drops than patients diagnosed by an ophthalmologist.
Worryingly, the study found the odds of filling a prescription depended more on a patient’s financial status than the patient’s risk for developing a more serious eye infection. For example, contact lens wearers and those with diabetes are more at risk.
Dr Shekhawat’s study, published in Ophthalmology – the journal of the American Academy of Ophthalmology, is the first of its kind to focus on outpatient management of acute conjunctivitis in the US.
Co-author and ophthalmologist Dr Joshua Stein, director of the Centre for Eye Policy and Innovation, says a new approach is needed for managing acute conjunctivitis:
“Educating patients about acute conjunctivitis’ often benign, self-limited course may help to dispel misconceptions about the condition and reduce reflexive demands for immediate antibiotic use.”
The specialists warn that there are several reasons why antibiotics are being overprescribed in cases of conjunctivitis:
- Cause unknown. It is a challenge to differentiate bacterial conjunctivitis from the viral and allergic forms. All three types may have overlapping features, such as a red eye, thin discharge, irritation and sensitivity to light. Doctors may be unsure of the cause and prescribe antibiotics “just in case.”
- School policies. Children with conjunctivitis may not be able to attend school or crèche unless they are being treated. In an accompanying editorial, such policies were called “highly inconvenient for patients and parents” and “devoid of evidence,” considering the more rapidly spreading viral conjunctivitis is unlikely to be influenced by a topical antibiotic.
- Lack of education. Patients are often unaware of the harmful side effects of antibiotics and may falsely believe that antibiotics are necessary for the infection to resolve.
