72 - QI Project to Reduce Unnecessary Use of Ophthalmic Antibiotics for Acute Conjunctivitis in the Pediatric Urgent Care Setting

Publication Number: 4070.72

Hayat Al Tabosh, Nationwide Children's Hospital, Columbus, OH, United States; Courtney Kirby, Nationwide Children's Hospital, Grove City, OH, United States; Jerry M. Stultz, Nationwide Children's Hospital, Columbus, OH, United States; Jessica Easdale, Nationwide Children's Hospital, Columbus, OH, United States; Eliana H. Kim, Nationwide Children's Hospital, Bethesda, MD, United States; Courtney Porter, Nationwide Children's Hospital, Dublin, OH, United States

Background: Acute conjunctivitis is a common urgent care chief complaint, as the symptoms are visible often keeping children out of daycare and school. Before the introduction of vaccines, pneumococcus was a common cause of conjunctivitis and was traditionally treated with topical antibiotics to prevent invasive disease. Post-vaccination, most cases of conjunctivitis are self-limited including those caused by haemophilus influenzae, yet ophthalmic antibiotics are still usually prescribed. Clear diagnostic guidelines differentiating bacterial from non-bacterial conjunctivitis are lacking, and national as well as return to school standards are variable.

Objective: The aim of this QI project is to reduce the prescription of ophthalmic antibiotics for patients presenting to the Nationwide Children's Urgent Care Network with signs and symptoms consistent with mild to moderate non-bacterial conjunctivitis by 50%. Secondary objective is to monitor the percentage of rebounds in cases that were not prescribed antibiotics.

Design/Methods: Retrospective data was collected for patients presenting to Nationwide Children's Urgent Care sites in 7 different locations between March of 2024 and March 2025. Neonates with gonorrheal or chlamydial conjunctivitis were excluded. Data showed that 60.5% of patients discharged with a diagnosis of non-bacterial conjunctivitis received an antibiotic prescription. Initial interventions aiming at reducing the percentage of unnecessary prescriptions included provider education about diagnosis and treatment of conjunctivitis during monthly staff meetings, nursing education about specific questions to ask during the triage process, and formulating a standardized letter detailing why an antibiotic was not necessary and suggesting limiting duration of exclusion from schools and daycares.

Results: Results spanning a 6-month-period showed a steady decline in the rate of ophthalmic antibiotic prescriptions by 16% with continued down trending projection (graph 1). There was no significant increase in rebound cases within 2 weeks of the initial encounter in cases that were not prescribed antibiotics (graph 2).

Conclusion(s): Educating providers and nursing staff about the self-limiting nature of acute conjunctivitis and when to initiate antibiotic treatment, in conjunction with addressing societal and return to school expectations has resulted in a promising and steady decline in antibiotic prescriptions without an increase in rebound cases. Future endeavors to standardize the diagnosis/management of conjunctivitis and national guidelines for return to school may transform the care of this common condition.

Graph 1
Percentage of patients prescribed antibiotics for non-bacterial conjunctivitis

Graph 2
Percentage of patients with non-bacterial conjunctivitis who were not prescribed antibiotics and rebounded within 2 weeks of the initial visit