A study of commercial insurance data found that more than two-thirds of children with acute conjunctivitis, or pink eye, received antibiotic eye drops, researchers reported today in JAMA Ophthalmology.
But whether or not children received topical antibiotics made no difference in subsequent healthcare use, a finding the researchers say suggests children with conjunctivitis are being overtreated.
Using data from the 2021 MarketScan Commercial Claims and Encounters Database, researchers from the University of California, San Francisco, Harvard University, and Boston Children's Hospital reviewed ambulatory care encounters involving an acute infective conjunctivitis diagnosis in children ages 1 to 17. They wanted to evaluate the frequency of topical antibiotic treatment and the association of antibiotic treatment with subsequent healthcare use, which was defined as ambulatory care revisits for conjunctivitis and revisits with same-day antibiotic dispensation.
Acute conjunctivitis can be caused by viruses, bacteria, or allergies, but most cases are mild and self-limited and topical antibiotics are rarely considered necessary, even when caused by a bacterial infection. Guidelines from the American Academy of Ophthalmology say indiscriminate use of topical antibiotics should be avoided in mild cases.
But several studies, the researchers note, have found that topical antibiotics are nonetheless frequently prescribed for the condition, which affects 1 in 8 US children and adolescents and results in millions of lost school days.
Revisits rare, regardless of initial treatment
Of the 44,739 ambulatory care encounters reviewed (median age, 5; 53% male), topical antibiotics were dispensed in 31,087 (69%), with less frequent dispensing observed after visits to eye clinics (34%), in children ages 6 to 11 years (66%), and in children diagnosed with viral conjunctivitis (28%).
Ambulatory care revisits for conjunctivitis within 14 days were rare, occurring after only 3.2% of index encounters (3.6% among those with topical antibiotics and 3.1% without), while all-cause revisits with same-day antibiotic dispensation occurred after 1.4% of index encounters (1.4% for both groups). Hospitalizations and emergency department revisits for conjunctivitis occurred for 0.03% and 0.12% of children, respectively.
Multivariable analysis found that topical antibiotic treatment was not associated with ambulatory care revisits for conjunctivitis (odds ratio [OR], 1.11; 95% confidence interval [CI], 0.99 to 1.25) or revisits with same-day topical antibiotic dispensation (OR, 1.10; 95% CI, 0.92 to 1.33). No differences were observed across exposure groups for hospitalizations or ED revisits.
"Revisits and new antibiotic dispensations were rare, regardless of initial topical antibiotic treatment, suggesting that not receiving antibiotics may not be associated with additional health care use," the authors wrote. "Given that antibiotics may not be associated with improved outcomes or change in subsequent health care use and are associated with adverse effects and antibiotic resistance, efforts to reduce overtreatment of acute infectious conjunctivitis are warranted."
