Antibiotics are being misused for viral and allergic conjunctivitis, where they are not only ineffective, but could also result in the development of resistance.
- Local antibiotic preparations are being over-prescribed for acute conjunctivitis, revealed a study in the United States
- The lack of diagnostic techniques and the expectations from the patients could be partly responsible
- Physicians should be encouraged to adopt evidence-based practices for acute conjunctivitis
A study that evaluated the prescription-filling patterns for acute conjunctivitis in the United States over 14 years was published in the Ophthalmology.
Infections are caused by various agents - viruses, bacteria, fungi, protozoa. The doctor differentiates between these infections during examination by conducting various tests, and prescribes antibiotics for bacterial infections only. Sometimes, the patient may start off with a viral infection, which could be followed by a bacterial infection due to reduced immunity.
‘Local antibiotics that are misused for non-bacterial conjunctivitis increase the risk of side effects and drug resistance, as well as the cost of treatment.’
What happens when a person takes antibiotics for a non-bacterial infection? The patient will take the same number of days to recover, irrespective of whether he or she is taking an antibiotic or not. There could also be some problems. The antibiotic may cause side effects that could have easily been avoided. Antibiotics, especially the newer ones, are expensive, and will add to the cost of treatment. Moreover, there is a chance of bacteria getting resistant to the antibiotics. This means, they will be ineffective when there might be a dire need for them.
In their study, the scientists found that antibiotic eye preparations were being over-prescribed for acute conjunctivitis. Conjunctivitis
is also called pink eye
or sore eyes. The eyes appear reddened, with itchiness and discharge. Though bacteria can cause conjunctivitis, viruses and allergies are often more common causes.
The authors of the study checked out prescriptions for acute conjunctivitis filled out by 3,40, 372 patients in the United States between the years 2001 through 2014. They found that:
An increased awareness about the potential harms of the inappropriate use of antibiotics, including local preparations for acute conjunctivitis, could go a long way in reducing the use of antibiotics.
- Around 58% patients filled one or more local antibiotic prescriptions within 14 days of the diagnosis. This appears to be inappropriate, since most cases of acute conjunctivitis are either due to viral infection or an allergy. Even mild bacterial infections may not require an antibiotic.
- One out of every 5 among these received an antibiotic-steroid combination. Such combinations should be avoided in acute conjunctivitis since steroids can actually prolong the duration of or worsen an infection.
- Patients at a higher risk for developing serious eye infection following acute conjunctivitis like those with HIV or contact lens users. filled antibiotic prescription at a similar frequency compared to those who were not at a higher risk. On the other hand, education and affluence appeared to play a role in filling antibiotic prescriptions, with the more educated and the affluent more likely to fill antibiotic prescriptions compared to the less affluent or less educated.
- The patients were more likely to fill an antibiotic prescription if they were first seen by an urgent care physician, internist, pediatrician or family practitioner as compared to an ophthalmologist.
Primary care physicians should receive adequate guidance to shift to evidence-based practices when it comes to prescribing an antibiotic for acute conjunctivitis
. Perhaps, the development and use of computer algorithms or tests could help to accurately differentiate between bacterial and viral infections which might aid physicians in taking correct decisions.
- Shekhawat NS, Shtein RM, Blachley TS, Stein JD. Antibiotic Prescription Fills for Acute Conjunctivitis among Enrollees in a Large United States Managed Care Network. DOI: http://dx.doi.org/10.1016/j.ophtha.2017.04.034