June 19, 2017
Is Your Doctor Prescribing the Wrong Treatment for Pink Eye?
Researchers at the University of Michigan Kellogg Eye Center looked at data from a large managed care network in the United States. They identified the number of patients who filled antibiotic eyedrop prescriptions for acute conjunctivitis. Then they evaluated the characteristics of patients who filled a prescription compared with those who did not.
Of approximately 300,000 patients diagnosed with acute conjunctivitis over a 14-year period, 58 percent filled a prescription for antibiotic eye drops. Among them, 20 percent filled a prescription for an antibiotic-steroid combination. Antibiotic-steroid drops are inappropriate for most patients with acute conjunctivitis because it may prolong or exacerbate certain types of viral infection.
Even more troubling, the authors found that the odds of filling a prescription depended more on a patient's socioeconomic status than the patient's risk for developing a more serious eye infection. For example, patients who wear contact lenses and those diagnosed with HIV/AIDS.
Pink eye affects 6 million people in the United States each year. There are three types: viral, bacterial, and allergic conjunctivitis. Antibiotics are rarely necessary to treat acute conjunctivitis. Most cases are caused by viral infections or allergies and do not respond to antibiotics. Antibiotics are often unnecessary for bacterial conjunctivitis because most cases are mild and would resolve on their own within 7 to 14 days without treatment.
The study also found:
"This study opens the lid on overprescribing of antibiotics for a common eye infection," said lead author Nakul S. Shekhawat, M.D., M.P.H. "It shows that current treatment decisions for pink eye are not based on evidence, but are often driven more by the type of health care practitioner making the diagnosis and the patient's socioeconomic status than by medical reasons. The potential negative consequences are difficult to justify as we move toward focusing on value in health care."
The authors say there are several reasons why antibiotics are over prescribed. 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. Health care providers may tend to "err on the side of caution" and prescribe antibiotics "just in case." Patients are often unaware of the harmful effects of antibiotics and may falsely believe that antibiotics are necessary for the infection to resolve.
The American Academy of Ophthalmology has issued guidance to the medical community on treatment for pink eye. The Academy tells health care providers to avoid prescribing antibiotics for viral conditions and to delay immediate treatment when the cause of conjunctivitis is unknown.
About the American Academy of Ophthalmology
The American Academy of Ophthalmology is the world's largest association of eye physicians and surgeons. A global community of 32,000 medical doctors, we protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public. We innovate to advance our profession and to ensure the delivery of the highest-quality eye care. Our EyeSmart® program provides the public with the most trusted information about eye health. For more information, visit www.aao.org.
SOURCE American Academy of Ophthalmology]]>