September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Substantial Over-Prescription of Antibiotics for Acute Conjunctivitis in the United States
Author Affiliations & Notes
  • Nakul Shekhawat
    W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, United States
  • Roni M Shtein
    W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, United States
  • Taylor Blachley
    W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, United States
  • Joshua D Stein
    W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, United States
    Institute for Health Care Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States
  • Footnotes
    Commercial Relationships   Nakul Shekhawat, None; Roni Shtein, None; Taylor Blachley, None; Joshua Stein, None
  • Footnotes
    Support  Research to Prevent Blindness; Kellogg Foundation
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 5539. doi:
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    • Get Citation

      Nakul Shekhawat, Roni M Shtein, Taylor Blachley, Joshua D Stein; Substantial Over-Prescription of Antibiotics for Acute Conjunctivitis in the United States. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5539.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Acute conjunctivitis is often caused by a virus, thus antibiotic therapy is usually unnecessary. We examined the extent that patients diagnosed with acute conjunctivitis are treated with topical antibiotics & factors associated with antibiotic use.

Methods : We analyzed health claims data from a large US managed care plan from 2001-2014. Eligible patients were diagnosed with acute conjunctivitis & continuously enrolled for >90 days after initial diagnosis. We excluded hospitalized patients, those undergoing eye surgery, or those with chronic conjunctivitis. Topical antibiotic use was defined as a prescription fill within 14 days of initial conjunctivitis diagnosis. Patient demographics, diagnosing provider, time to prescription fill, & antibiotic class were studied. Multivariable logistic regression determined factors associated with antibiotic use.

Results : Of 340,630 patients diagnosed with acute conjunctivitis, 198,511 (58%) filled prescriptions for topical antibiotics. 20% of patients (N=38,774) filled prescriptions for combined antibiotic-steroids, which are contraindicated in acute infectious conjunctivitis. Prescription fills differed by age, race, income & diagnosing provider (all p<0.001) but not contact lens wear (p=0.58) or HIV diagnosis (p=0.36) (Table 1). Whites, those with higher incomes, and more educated patients had higher odds of receiving antibiotics for acute conjunctivitis compared with non-whites, less affluent and educated patients (all p<0.0001) (Table 2). Compared to patients diagnosed by ophthalmologists (37% fill), patients had higher percentages & odds of antibiotic fill if diagnosed by urgent care MDs (68% fill; OR 3.02, CI 2.91-3.13), internists (58%; OR 2.64, CI 2.55-2.74), family practice MDs (55%; OR 2.31, CI 2.23-2.40), pediatricians (59%; OR 2.17, CI 2.03-2.32), and optometrists (45%; OR 1.19, CI 1.15-1.24). Patients with HIV were no more likely to receive antibiotics (p=0.81) and those with end-organ damage from diabetes were 18% less likely to get antibiotics (p<0.0001) compared to patients without these conditions.

Conclusions : We identify rampant over-prescription of antibiotics for conjunctivitis in the US among insured patients, including potentially harmful practices that may increase costs, prolong infection duration, & lead to antibiotic resistance. Antibiotic use appears to be driven more by sociodemographic factors & provider type than medical indication.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

 

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