NEW YORK—Medical experts are sounding the alarm about overprescribing antibiotics for children suffering from pink eye, according to a new study published in JAMA Ophthalmology. Pink eye is an inflammation of the transparent membrane that lines the eyelid and eyeball. According to the study titled Antibiotic Treatment and Health Care Use in Children and Adolescents With Conjunctivitis, authored by Dr. Daniel J. Shapiro, Dr. Alexandra T. Geanacopoulos, and Dr. S. V. Subramanian, topical antibiotics were dispensed within one day after hospital visits in 69 percent of pink eye cases. The number dropped significantly after a visit to the eye clinic where antibiotics were prescribed in 34 percent of cases.

The study used a nationwide database of insurance claims from 2021. Of the nearly 45,000 children who received care for pink eye at emergency rooms and doctor's offices, 69 percent were prescribed antibiotics.

The American Academy of Ophthalmology stated that children are the people most likely to get pink eye from bacteria or viruses due to their close contact with so many other children in school or day care centers. Poor hygiene is also another factor that can lead to an increased risk of developing the disease in children. 

Experts believe the frequency of cases and use of antibiotics is significantly reduced in an eye clinic setting. This may be due to the wider range of treatment options within an eye clinic and a greater understanding of the disease. 

The study noted that return visits to health care providers for pink eye were rare at 4 percent, whether the patients were treated or not. This result indicates that antibiotics were not necessarily required for successful treatment outcomes, instead, experts believe finding the root causes of pink eye leads to improved treatment results. 

“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,” Dr. Shapiro said. “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.”

Reducing the rates of antibiotic use was also found to have a significant impact on the U.S. medical system. A 2023 study published in Pearl Stats, titled Viral Conjunctivitis, found improvement in diagnostic rates of viral conjunctivitis is estimated to have reduced inappropriate antibiotic prescribing and saved $430 million per year in the United States.

“There is a considerable economic and societal impact due to the costs of visits to the emergency department or general practitioner, diagnostic tests, prescription treatment, and time lost from work or school,” said study author professor Daniel Solano of Nova Southeastern University. “Prescribing antibiotics in cases of viral conjunctivitis is one of the major costs of any health care system.”

The Pearl Stats study noted the use of povidone-iodine, a non-specific disinfectant, is recommended as a new alternative treatment.

“It does not induce drug resistance because its mechanism of action is not immunologically dependent. A single dose of 2.5 percent povidone-iodine in infants with adenoviral conjunctivitis resulted in a reduction in symptom severity and reduced recovery time without significant side effects,” said Solano. 

There are several treatment options for pink eye. A recent article in Review of Optometry, titled The Conjunctivitis Conundrum by Ernie Bowling, OD, recommended removal of the symptom-causing allergen before moving on to the more expansive treatments, followed by several non-antibiotic treatment options. 

“The most commonly used medications for ocular allergy therapy are the multi-action agents that exert multiple pharmacological effects. These include olopatadine, ketotifen, azelastine, epinastine and bepostatine,” Dr. Bowling said. “These medications are the drugs of choice for providing quick symptomatic relief to patients suffering from acute conjunctivitis. When these medications do not yield the control desired, the next step is anti-inflammatory agents. Non-steroidal anti-inflammatory drugs (NSAIDs) can be added to reduce symptoms.”

Dr. Bowling noted that the condition is self-limiting, generally running its course in a few days, while the nodular form may last for weeks. He added many patients may require treatment for the redness and discomfort, adding non-medicinal options such as cold compresses and artificial tears provide symptomatic relief. 

Dr. Bowling added, “Conjunctivitis encompasses a wide range of diseases occurring worldwide. It rarely causes permanent vision loss, but its impact on patients’ quality of life can be considerable. It can cause them to miss work or school, not to mention its effect on the wallet. Our clinical duty is to properly diagnose and, when necessary, treat this condition, whatever its origin, with a targeted approach.”