Antibiotic Use Not Associated with Healthcare Revisits for Conjunctivitis

A recent investigation in JAMA Ophthalmology evaluated the frequency of topical antibiotic treatment and its association with healthcare use among children and adolescents with acute infectious conjunctivitis in the United States.¹

More than two-thirds of US commercially insured children with conjunctivitis filed a prescription for topical antibiotics within a single day of an ambulatory care visit. On the other hand, revisits and new antibiotic dispensations remained few, irrespective of initial antibiotic treatment.

“Children who were initially evaluated in eye clinics were infrequently treated with topical antibiotics but had more frequent ambulatory care revisits when antibiotics were dispensed, suggesting a higher threshold for treatment and closer follow-up care for presumed bacterial conjunctivitis,” wrote the investigative team, led by Daniel Shapiro, MD, MPH, UCSF Pediatric Emergency Department.

A common ocular condition in the pediatric population, approximately 1 in 8 children are affected by pink eye annually in the US. The American Academy of Ophthalmology (AAO) has indicated that non-immediate treatment is safe and effective in most circumstances, but antibiotics are frequently prescribed for children.

Most cases remain mild and self-limited, centering the burden of conjunctivitis around the costs of medical visits and missed school or work, rather than its clinical presentation. For this analysis, Shapiro and colleagues searched a MarketScan database for individuals aged 1–17 years with conjunctivitis diagnosed during ambulatory care encounters.

For analysis, the primary exposure was a topical antibiotic prescription dispensed within 1 day of the index encounter. Outcomes were assessed 2 to 14 days after the index encounter. Primary outcomes included ambulatory care revisits for conjunctivitis with the same-day dispensation of a new topical antibiotic.

After performing exclusions in the search, 44,793 ambulatory care encounters were included for analysis. Children had a median age of 5 years and were 47% (n = 21,210) female and 53% (n = 23,583) male.

Topical antibiotics were dispensed within 1 day after 31,087 encounters (69%) according to the results. They were less frequently dispensed after visits to eye clinics (34%), in children aged 6 to 11 years (66%), and in children with viral conjunctivitis (28%).

Moreover, ambulatory care revisits within 14 days for conjunctivitis were identified after 3.2% (95% CI, 3.1 - 3.4) of index encounters. All-cause revisits with a same-day antibiotic dispensation were found after 1.4% (95% CI, 1.3 - 1.5) of index encounters.

After multivariable analysis, Shapiro and colleagues found topical antibiotic treatment was not associated with ambulatory care revisits for conjunctivitis (adjusted odds ratio [aOR], 1.11; 95% CI, 0.99 - 1.25) or revisits with same-day topical antibiotic dispensation (aOR, 1.10; 95% CI, 0.92 - 1.33).

Conjunctivitis-related hospitalizations were identified in 0.03% of children and emergency department revisits in 0.12%, without a difference across exposure groups. For children initially assessed in eye clinics, ambulatory care revisits occurred for 9.5% of the population.

Overall, antibiotic treatment was linked with an increased likelihood of ambulatory care revisits (aOR, 1.84; 95% CI, 1.36 - 2.48).

“Given that antibiotics may not be associated with improved outcomes or changes in subsequent health care use and are associated with adverse effects and antibiotic resistance, efforts to reduce overtreatment of acute infectious conjunctivitis are warranted,” they added.

References

1. _{Shapiro DJ, Geanacopoulos AT, Subramanian SV, Wu AC, Bardach NS, Oke I. Antibiotic Treatment and Health Care Use in Children and Adolescents With Conjunctivitis. JAMA Ophthalmol. Published online June 27, 2024. doi:10.1001/jamaophthalmol.2024.2211}