The use of antibacterial treatment for acute pediatric infectious conjunctivitis is inconsistent among clinicians and influenced by several non-medical factors, according to research published in the Journal of the American Association for Pediatric Ophthalmology and Strabismus.
Researchers conducted semi-structured interviews with 20 clinicians and advanced practice practitioners (APPs) serving in primary care, urgent care, and emergency departments. The primary objective was to understand the rationale behind how clinicians manage acute pediatric infectious conjunctivitis and factors that could reduce the unnecessary prescription of antibiotics. Questions were based on literature reviews and past qualitative research, and interviewers used both inductive and deductive content analysis methods.
Overall, clinicians reported 5 primary driving factors that prompted their decision to prescribe or withhold antibiotic treatment. They stated that clinical presentations, family expectations, antibiotic stewardship concerns, diagnostic uncertainty and school or daycare policies influenced treatment decisions.
Practitioners stressed how family members put pressure on them to prescribe antibiotics. According to the clinicians, parents and caregivers felt that antibiotic treatment was necessary for their children to return to school or daycare (n=20), would prevent the spread to others (n=13), or ease their child’s discomfort (n=8). A majority of clinicians surveyed were aware of antibiotic overuse for common pediatric infections (n=15) and reported being challenged by the desire to not prescribe unnecessary antibiotics despite familial pressure.
Five practitioners reported that their ophthalmic antibiotic prescribing rates were higher during the COVID-19 pandemic due to an increase in nurse-line visits. All clinicians surveyed reported instituting nurse-line specific protocols that allowed nurses to prescribe ophthalmic antibiotics without their approval during the pandemic.
A majority of clinicians (n=12) called for infectious conjunctivitis guidelines to avoid prescribing antibiotics unnecessarily and no survey participants stated they were aware of how to locate standardized treatment guidelines for return to school.
“This study is a call to action for the creation of a pediatric specific national guideline for the management of conjunctivitis along with updated school/daycare exclusion policies,” according to the researchers. “This dual strategy could help reduce unnecessary and potentially harmful antibiotic use, as well as socioeconomic and healthcare burdens associated with exclusion policies.”
Study limitations included the likelihood of sample and selection bias, inability to fully assess the accuracy of prescribing patterns, and possible social-desirability bias in interviews.
Sebastian T, Frost HM. A qualitative evaluation of pediatric conjunctivitis medical decision making and opportunities to improve care. J AAPOS. Published online April 11, 2022. doi:10.1016/j.jaapos.2021.12.008