Management of Bacterial Conjunctivitis in Children-Preferred Practice Pattern in Northern Greece.

To the Editor: There seems to be no universal consensus regarding the management of acute bacterial conjunctivitis: there is evidence that antibiotics speed resolution of symptoms and modestly improve rates of remission; however, most cases resolve spontaneously and some clinicians advise caution for inappropriate or needless use of antibiotics and its negative consequences.1,2 This study aimed to assess the current preferred practice in Northern Greece. A questionnaire (Table 1) was randomly distributed during major scientific meetings to a group of pediatricians, ophthalmologists, and general practitioners (GPs). A simple random scheme was used to select 10% of the participants in each scientific meeting that was held in Thessaloniki, Northern Greece. Anonymous questionnaires were given to 225 doctors and returned completed by 169 of them (participation 75.11%). Demographics of participants are shown in Table 2. Two thirds of pediatricians (46/69), 73% of ophthalmologists (44/60), and 25% of GPs (10/40) replied that they prescribe an antibiotic drop, whereas less than 10% in all groups prescribe artificial tears only. Fifteen to twenty percent of all doctors prescribe steroids, alone or in combination with antibiotics, and 36% to 60% of them do so for more than 5 days. Notably, a third of pediatricians and ophthalmologists and 15% of GPs prescribe steroid drops and do not reexamine the patient. Prescription of drops for more than 5 days is what 65% of pediatricians do, 52% of ophthalmologists, and 60% of GPs. There was no significant association in preferred practice patterns in doctors trained before or after 2000 (x2 test, pediatricians: P=0.198, ophthalmologists: P=0.098, and GPs: P=0.083). It seems that most Greek physicians do prescribe topical antibiotics for bacterial conjunctivitis in children, possibly because of expectations of the familial and social environment.3 Interestingly, a considerable number of doctors prescribe steroid drops. Antibiotics increase the risk of producing resistant strains of bacteria, and this issue has serious long-term implications, but at least antibiotics have been proven beneficial in certain regards.1,4 Steroids on the other hand, have potential serious side effects, including ocular hypertension, herpetic keratitis exacerbation, glaucoma and cataract, and even side effects from systemic absorption, if they are used at a frequent enough dose and duration. These side effects make their prescription unjustifiable for a benign, selflimiting condition such as acute bacterial conjunctivitis, especially if appropriate follow-up is not met to exclude side effects’ occurrence. This survey’s results underline the need for continuing medical education aiming to raise awareness of these issues among care providers for children and to increase vigilance for judicious management of such a common condition.