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Diep I, Widagdo I. Use of 'number needed to treat' in optometry practice. Clin Exp Optom 2024; 107:349-350. [PMID: 38173424 DOI: 10.1080/08164622.2023.2288178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/18/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
| | - Imaina Widagdo
- Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), Clinical and Health Sciences, University of South Australia, Adelaide, Australia
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Siegel H, Lang S, Maier P, Reinhard T. [Bacterial Conjunctivitis: Current Aspects of Diagnosis and Therapy]. Klin Monbl Augenheilkd 2024; 241:231-246. [PMID: 37977204 DOI: 10.1055/a-2193-2658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Bacterial conjunctivitis is a leading cause of infectious conjunctivitis in children and second most common cause in adults. Although often self-limiting, it can lead to complications like corneal scarring and systemic infections in high-risk groups including newborns and immunocompromised patients. Thus, prompt diagnosis and treatment are essential for these vulnerable populations. Common bacterial causes are Staphylococcus aureus and Streptococcus pneumoniae in adults and Haemophilus influenzae and Moraxella catarrhalis in children. Clinical features alone do not reliably identify the causative pathogen. Microbiological testing is necessary for persistent or severe cases. Topical antibiotics like azithromycin or fluorochinolones are usually prescribed. However, gonococcal and chlamydial conjunctivitis warrant systemic antibiotics due to their potential for severe complications. Increasing antibiotic resistance might even necessitate tailored therapy based on antibiotic susceptibility profiles. Screening and treating pregnant women is an effective prevention strategy by reducing perinatal transmission (especially of gonococcal and chlamydial infections). In summary, while often self-limiting, potential complications and rising antibiotic resistance underscore the importance of timely diagnosis and treatment of bacterial conjunctivitis. Preventive measures including maternal screening are crucial public health initiatives to curb the risks associated with this common eye infection.
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Sebastian T, Durfee J, Wittmer N, Jack J, Keith A, Jenkins TC, Frost HM. Reducing Ophthalmic Antibiotic Use for Non-severe Conjunctivitis in Children. J Pediatric Infect Dis Soc 2023; 12:496-503. [PMID: 37696521 PMCID: PMC10533209 DOI: 10.1093/jpids/piad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Antibiotics are often overprescribed for pediatric conjunctivitis. We implemented a system-level quality improvement (QI) intervention to reduce unnecessary ophthalmic antibiotic use. METHODS The multi-faceted intervention in Denver, CO comprised a clinical care pathway, nurse protocol modifications, electronic health record (EHR) changes, parent education materials, and clinician education. We evaluated children aged 6 months-17 years with conjunctivitis seen between November 2018 and December 2022. A multi-interrupted time series model evaluated the effectiveness of the intervention over three time periods: Pre-COVID, Pre-Intervention (November 2018-February 2020), COVID, Pre-Intervention (March 2020-March 2021), and Post-Intervention (April 2021-December 2022). Fisher's exact tests compared treatment failure and healthcare utilization rates between time periods and among children receiving or not receiving ophthalmic antibiotics. RESULTS Among 6960 eligible encounters, ophthalmic antibiotic use was reduced by 18.8% (95% CI: 16.3, 21.3) from Pre-COVID, Pre-Intervention to Post-Intervention. During the Pre-Intervention period following the onset of COVID, a reduction of 16.1% (95% CI: 12.9, 19.3) was observed. Implementation of the intervention resulted in an additional 2.7% (95% CI: -0.4, 5.7) reduction in antibiotic prescribing, primarily in younger children (ages 6 months-5 years). The greatest reduction in prescribing occurred for nurse triage encounters with an 82.1% (95% CI: 76.8, 87.5) reduction in prescribing rates (92.6%-10.5%). Treatment failure occurred in 1301 (18.7%) children and was more common among children that received an ophthalmic antibiotic than those that did not (20.0 vs 17.9%; P = .03). CONCLUSION The QI intervention significantly reduced ophthalmic antibiotic prescribing for pediatric conjunctivitis without increasing treatment failure rates or health care utilization.
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Affiliation(s)
- Thresia Sebastian
- Department of Pediatrics, Denver Health and Hospital Authority, Denver, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, Alameda Health System, Oakland, Calofornia, USA
| | - Josh Durfee
- Center for Health Systems Research, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Nancy Wittmer
- Center for Health Systems Research, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Jessica Jack
- Department of Pediatrics, Denver Health and Hospital Authority, Denver, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amy Keith
- Center for Health Systems Research, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Timothy C Jenkins
- Division of Infectious Diseases and Department of Medicine, Denver Health and Hospital Authority, Denver, Colorado, USA
- Division of Infectious Diseases and Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Holly M Frost
- Department of Pediatrics, Denver Health and Hospital Authority, Denver, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for Health Systems Research, Denver Health and Hospital Authority, Denver, Colorado, USA
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