CONJUNCTIVITIS typically resolves without intervention, according to Holly M. Frost, Centre for Health Systems Research at Denver Health, Colorado, USA. However, it was noted that despite this understanding, approximately 73% of paediatric patients were being prescribed antibiotic eye drops or ointments for routine conjunctivitis. Hence, Frost and colleagues set out to curtail the unnecessary use of antibiotics in such cases.
The research team implemented a quality improvement intervention for pink eye at Denver Health’s extensive network, encompassing 32 healthcare clinics, three urgent care centres, a paediatric emergency department, and the Denver public school district.
This initiative entailed the development of a critical care guideline accessible to all healthcare providers within the participating institutions. It included updated protocols for nurses to guarantee the avoidance of unnecessary antibiotic prescriptions. Additionally, educational materials were designed for both parents and clinicians to enhance awareness and understanding of the condition, and its appropriate management.
The study divided the timeline into distinct periods for analysis. The first period, labelled the pre-COVID-19 preintervention period, spanned November 2018–February 2020. The subsequent phase, termed the COVID-19 preintervention period, extended from March 2020–March 2021. Finally, the postintervention period commenced in April 2021, and continued until December 2022.
Among the 6,960 eligible encounters studied, the authors observed several significant reductions in ophthalmic antibiotic use. Firstly, there was an 18.8% reduction from the COVID-19 preintervention period to the postintervention period. Secondly, during the preintervention period that followed the onset of COVID-19, there was a 16.1% reduction. Lastly, there was a substantial 82.1% reduction in prescribing rates for nurse triage encounters. These findings underscore the effectiveness of the intervention in reducing antibiotic usage for paediatric conjunctivitis.
“The interventions also reduce inequities in conjunctivitis care for kids,” noted Frost. “We found, for example, that the gap in care between Black and White children reduced to less than 1%. We similarly observed reductions in disparities between Latino and non-Latino children. So, in general, these interventions promote standardised care, and contribute to greater equity in the treatment of conjunctivitis.”
Additionally, the researchers reported that treatment failure occurred in 18.7% of children overall. Notably, it was more common among children who received antibiotics (20.0%) compared to those who did not (17.9%). These findings emphasise the potential benefits of reduced antibiotic use in the management of paediatric conjunctivitis.
