ASP Scan (Weekly) for Jun 23, 2017

Antibiotic-free fast-food chicken
MRSA in Norway, Kuwait
NDM-1 at Mexican hospital
Stewardship in long-term care
Statement on antimicrobial products
Types of prescribers
New antibiotic OK'd
MDR-TB in US kids
Virus tests and stewardship
Penalties for poor Rx
US Candida auris
Resistance testing
Surgical antibiotic prophylaxis
MRSA screen and vancomycin
Antibiotics for 'pink eye'

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Burger King, Tim Hortons to end use of chicken raised with antibiotics

The company that owns fast-food chains Burger King and Tim Hortons has vowed to stop purchasing chicken raised with antibiotics that are also used in human medicine, according to Reuters.

Restaurant Brands International Inc said its brands, which also include Popeye's Louisiana Chicken, will switch to chicken raised without medically important antibiotics by the end of 2018.

With the move, the company is following in the footsteps of other fast-food chains—including McDonald's, Wendy's, Chik-fil-A, and Kentucky Fried Chicken—that have said they will cut the use of medically important antibiotics in their chicken supply. According to a press release from the Natural Resources Defense Council (NRDC), 11 of the top 15 chains in the United States have now committed to some level of responsible antibiotic use in their chicken supply.

"With this commitment, Burger King and Tim Hortons are helping keep our lifesaving drugs working when sick people need them," NRDC food policy advocate Lena Brooke said in the press release.

According to estimates, about 70% of all medically important antibiotics sold in the United States are used in poultry and livestock production. Public health officials are concerned that the widespread use of medically important antibiotics in food-producing animals is contributing to antibiotic resistance.
Jun 22 Reuters story
Jun 22 NRDC press release


Researchers investigate MRSA infections in Norway, Kuwait

A study yesterday in PLoS One suggests that immigration and importation are responsible for an increase in methicillin-resistant Staphylococcus aureus (MRSA) infections in Norway, while another study in the same journal revealed that community-associated MRSA strains were prevalent among MRSA isolates from a Kuwaiti maternity hospital.

In the study on Norway, which has one of the lowest prevalence of MRSA infections in the world but has seen an increase in the incidence of MRSA isolates since 2011, researchers investigated recent trends by analyzing national registry data from 2006 through 2015. They placed particular emphasis on characterizing the temporal patterns of domestic vs. imported infections, stratified by age and by Norwegian versus immigrant background.

A total of 5,289 MRSA infections were reported in Norway during the study period, with 2,255 (42.6%) acquired in Norway, 1,370 (25.9%) acquired abroad, and 1,664 (31.5%) with an unknown place of acquisition. Infections from abroad were mainly acquired in Asia (43.3%) and Europe (24.9%). Over the course of the study, the proportion of imported infections tied to tourism decreased, while the proportion of infections related to immigrants arriving in Norway and to family visits abroad increased.

A time series analysis showed that the monthly notification rate (NR) rose by 0.8% each month, from 0.51 per 100,000 people at the beginning of the study to 1.41 at the end, corresponding to a rise from 24 monthly cases to 73. A significant association between this increase and the total number of international flights arriving in Norway was found, with seasonal peaks in the summer.

While the researchers observed a significant monthly increase in the NR for both immigrants and those with a Norwegian background, by the end of the study the NR for immigrants was 3.21, more than three times higher than the NR for native Norwegians (0.93). In addition, they identified a significant increase in the rate of domestically acquired infections (0.4% per month), but the NR of infections acquired abroad increased faster (0.8% per month). The strongest increase was observed in people 19 years and younger.
Jun 22 PLoS One study

In the other PLoS One study, Kuwaiti researchers analyzed MRSA isolates collected from 2006 to 2011 at a Kuwaiti maternity hospital to determine their genetic relatedness. The hospital has seen a gradual increase in MRSA incidence since 2005.

Molecular typing of the 103 MRSA isolates obtained from 64 neonates, 17 adult patients, and 12 healthcare workers revealed that 66.9% had community-associated MRSA (CA-MRSA) genotypes. The MRSA population was dominated by internationally recognized clonal complexes and consisted of known strains that have been previously reported in Kuwait, such as ST239-III-t680, ST22-IV-t223/t852, and ST80-IV-t044. But a novel strain, ST5-V-t022, was identified as the major clone. The number of MRSA isolates increased from two in 2006 to 22 in 2011, with a peak of 43 in 2008.

"The high prevalence of CA-MRSA observed in this study mirrors recent observations in other centers where CA-MRSA are the dominant MRSA isolates obtained from neonatal units," the authors write.
Jun 22 PLoS One study


NDM-1 gene identified in CRE isolates at Mexican hospital

Originally published by CIDRAP News Jun 22

Researchers have identified four Enterobacteriaceae species harboring the carbapenem-resistance gene NDM-1 among isolates collected at a tertiary care hospital in Mexico, according to a study yesterday in PLoS One.

Of the more than 3,000 isolates collected at the hospital from September 2014 to July 2015 following detection of an outbreak of carbapenem-resistant Enterobacteriaceae (CRE), 86 (2.83%) were found to be carbapenem resistant and carbapenemase producers, and 52 isolates (one per patient) were selected for further study. Carbapenemase-producing species included Klebsiella pneumoniae (46 isolates), Enterobacter cloacae (3), Escherichia coli (1), Providencia rettgeri (1), and Citrobacter freundii (1). Fifty-one of the 52 isolates were classified as multidrug-resistant.

The NDM-1 gene was detected in 46 K pneumoniae isolates, 3 E cloacae isolates, 1 E coli isolate, and 1 P rettgeri isolate, for a total of 51. Other carbapenemase genes detected included VIM, IMP, and KPC. The transfer of plasmids harboring the NDM-1 gene was obtained in eight transconjugants.

Analysis of clonal diversity revealed that 60% of the K pneumoniae isolates belonged to clone A, corresponding to the ST392 strain. The ST307, ST309, ST846, ST2399, and ST2400 strains were also detected in K pneumoniae. The E coli isolate corresponded to ST10, and the E cloacae isolate corresponded to ST182.

"The results obtained in this study indicate that blaNDM-1 was disseminated horizontally among different species in a tertiary care hospital in Mexico, also with proof of strain spread predominantly of K. pneumoniae ST392," the authors write. "We have provided evidence of plasmid transfer but, given the variation in plasmid sizes, complex rearrangements must also be occurring."

The authors note that while the detection of more than one CRE species and multiple carbapenemase genes in the same hospital in the same period has previously been reported, it's been in countries distant from Mexico (China and Kuwait). "Because of this, our report underscores the importance of active surveillance in all enterobacterial species," they write. 
Jun 21 PLoS One study


Review identifies factors to boost stewardship in long-term care

Originally published by CIDRAP News Jun 21

A literature review of antimicrobial stewardship activities at long-term care facilities (LTCFs) that focused on workflow systems identified factors that were effective and possibly complementary, researchers reported yesterday in Clinical Infectious Diseases.

They noted that LTCFs face different antimicrobial stewardship challenges than hospitals do, and identifying the useful interventions is especially important, given Centers for Medicare and Medicaid Services (CMS) rule changes requiring antimicrobial stewardship activities in LTCFs.

Of 20 studies on antimicrobial stewardship interventions at LTCFs that met the research criteria, 5 were randomized controlled trials and 15 were quasi-experimental analyses.

The effective approaches they found included multidisciplinary education supported by enduring material, integrating pre-prescription data collection tools into nurses' workflow, integrating post-prescription recommendations into prescribers' workflow, and using infectious disease experts as external consultants.

Structured education that involves nurses, nurse assistants, and prescribers may be a feasible and practical strategy, especially when combined with comprehensive approaches, such as incorporating actionable items into pocket guides and posting educational materials in common areas, the team concluded. They noted that education alone might be enough to start antimicrobial stewardship, but it isn't enough to sustain it.

Communication between people with different roles at LTCFs seems vital, the experts wrote, and, ideally, tools supporting antimicrobial stewardship, especially gathering relevant clinical information before prescribing and fostering communication among staff, will become embedded in electronic medical record systems.
Jun 20 Clin Infect Dis abstract


Scientists, medical experts warn of antimicrobial chemical hazards

Originally published by CIDRAP News Jun 21

A statement signed by more than 200 scientists and medical professionals is calling on the international community to limit the production and use of triclosan and triclocarban, two antimicrobial ingredients widely used in over-the-counter antibacterial soaps and thousands of other consumer products.

The Florence Statement on Triclosan and Triclocarban, written in 2016 and published yesterday in Environmental Health Perspectives, says that continued use of the chemicals is concerning because peer-reviewed research has concluded that they are environmentally persistent endocrine disruptors that bioaccumulate in aquatic plants and organisms and have been associated with reproductive and developmental harm in animals. The authors also say there's no evidence that use of triclosan and triclocarban improves consumer health or prevents disease, and that overuse may contribute to antimicrobial resistance and may modify the microbiome.

"We therefore call on the international community to limit the production and use of triclosan and triclocarban and to question the use of other antimicrobials," the authors write.

In September 2016, the US Food and Drug Administration (FDA) banned triclosan and triclocarban, along with 17 other active antimicrobial agents used in consumer antiseptic washes, saying that manufacturers had not demonstrated that the ingredients are safe for long-term daily use or are more effective than plain soap and water in preventing illness or infection. The FDA gave manufacturers 1 year to phase out or reformulate products using the chemicals.

The FDA ban, however, does not apply to hand sanitizing gels, foams, or wipes and doesn't limit use of the chemicals in healthcare settings. In addition, the statement notes that many of the chemicals are still used in other consumer and building products.  The authors of the statement say the narrow scope of the FDA's ruling indicates that "existing regulatory practices are not sufficient to protect human and ecosystem health from adverse impacts of antimicrobial chemicals."

The statement urges governments, chemical and product manufacturers, and consumers to avoid use of triclosan, triclocarban, and other antimicrobial chemicals except where they provide an evidence-based health benefit, and to use safer alternatives that pose no risk to humans or ecosystems. 
Jun 20 Environ Health Perspect statement


Study finds higher antibiotic prescribing in docs who dismiss risks

Originally published by CIDRAP News Jun 21

Physicians who perceive the risks posed by antibiotics as low are more likely to prescribe them than those who consider potential side effects to be a concern and understand the problem posed by antibiotic resistance, according to a study yesterday in the Journal of General Internal Medicine.

US investigators analyzed data on 2,874 patient visits involving an antibiotic prescription for pneumonia or upper respiratory tract infection in 2014 and 2015. The prescriptions were written by 69 emergency department clinicians, and prescribing rates ranged from 7% to 91%.

Clinicians who framed prescribing decisions as a choice between continued illness and possible benefit (a "why not take a risk?" gist) had higher rates of prescribing (odds ratio [OR], 1.28). In contrast, those who tended to agree with the "antibiotics may be harmful" gist were associated with about a 50% lower prescribing rate (OR, 0.81). (Using the "gist" approach to categorizing prescribers is based on what researchers call "fuzzy-trace theory.")

Study author Eili Klein, PhD, a fellow with the Center for Disease Dynamics, Economics & Policy (CDDEP) said in a CDDEP news release, "What's needed are interventions that change the mental calculus of clinicians. The 'just to be safe' mentality of many clinicians doesn't recognize the potential harms of antibiotic treatment or consider the further development of antimicrobial resistance."

"Interventions that explicitly focus on changing providers' gists, such as by emphasizing that even rare side effects can happen eventually, or that antibiotic resistance may hurt the patient in the event of a future illness, are more likely to be effective," added co-author David Broniatowski, PhD.
Jun 20 J Gen Intern Med study
Jun 21 CDDEP news release


New fluoroquinolone for bacterial skin infections wins FDA approval

Originally published by CIDRAP News Jun 20

A new fluoroquinolone antibiotic, delafloxacin (Baxdela), for acute bacterial skin and skin structure infections (ABSSSI) in adults gained approval yesterday from the FDA, according to Melinta Therapeutics, the manufacturer.

Delafloxacin is active against both gram-positive and gram-negative bacteria, including MRSA, the company said in a press release. It is available in oral and intravenous (IV) formulations.

"The approximately 3 million patients hospitalized each year in the US with ABSSSI often present treatment challenges owing to their underlying medical conditions, making optimal antibiotic selection difficult," said Melinta CEO Eugene Sun, MD. "Baxdela provides a treatment option for adult patients with ABSSSI based on its coverage spectrum, IV and oral dosing flexibility, efficacy and safety profile."

The company reported that two phase 3 studies in patients with ABSSSI showed that IV and oral delafloxacin monotherapy was statistically non-inferior to the combination of vancomycin and aztreonam at the FDA primary endpoint of early clinical response at 48 to 72 hours. The drug was well tolerated, with a 0.9% discontinuation rate due to adverse events.

In addition, delafloxacin has not shown any potential for QT-segment prolongation or phototoxicity in definitive clinical studies, Melinta said, adding, "There have been no signs of adverse effects on liver function, kidney function, or glucose regulation in controlled clinical studies." The 450-mg tablet is biologically equivalent to the 300-mg IV dose and can be given without regard to food intake, the statement said. There are no anticipated drug interactions with delafloxacin other than with chelating agents, such as antacids.

Gram-negative ABSSSIs for which delafloxacin is indicated include those caused by E coliE cloacaeK pneumoniae, and Pseudomonas aeruginosa, according to Melinta.

The FDA gave the drug priority review because of its designation as a Qualified Infectious Disease Product (QIDP) under the Generating Antibiotic Incentives Now (GAIN) Act of 2012, the company noted.
Jun 19 Melinta press release
FDA information on delafloxacin


CDC findings suggest MDR-TB burden in US children is underestimated

Originally published by CIDRAP News Jun 20

National surveillance suggests that the rate of multidrug-resistant tuberculosis (MDR-TB) in US children over a recent two-decade period was less than 2%, but the limited use of bacteriologic testing in TB cases means the true rate is probably higher, according to federal, state, and local researchers.

The findings by authors from the Centers for Disease Control and Prevention (CDC), California, Minnesota, and New York City were published yesterday in Clinical Infectious Diseases.

They analyzed data on newly diagnosed TB cases in children under age 14 that were reported to the National TB Surveillance System (NTSS) from 1993 through 2014. MDR TB was defined as culture-confirmed TB disease with resistance to at least isoniazid and rifampicin. To assess potential underestimation of pediatric MDR-TB, they surveyed high-TB–burden states for clinically diagnosed cases that were treated for MDR-TB.

Of 20,789 pediatric TB cases, 5,162 (24.8%) involved bacteriologically confirmed disease, the team found. Among 4,862 (94.2%) cases with drug-susceptibility testing, 82 (1.7%) involved MDR-TB. Fifty-one of the 82 (62%) patients were female, with a median age of 5 years. A third (28; 34%) were Hispanic, and two-thirds (55; 67%) were born in the United States.

Most cases (66; 80.5%) showed resistance to at least one other first-line drug, and one-third (24 of 73 tested) were resistant to one or more second-line drugs, the report says. Of 77 patients who started treatment before 2013, 66 (86%) completed treatment and 4 (5%) died.

The researchers calculated that among the four high-burden states and jurisdictions surveyed, pediatric MDR-TB cases were underestimated by 42% to 55% when using only culture-confirmed case definitions.

"Only one-quarter of pediatric TB cases had culture-confirmed TB, likely resulting in underestimation of true pediatric MDR TB burden in the US using strictly bacteriologic criteria," the team concluded. "Better estimates of pediatric MDR TB burden in the US are needed and should include clinical diagnoses based on epidemiologic criteria."
Jun 19 Clin Infect Dis abstract


Study: Testing for flu—but not other viruses—affects prescribing

Originally published by CIDRAP News Jun 20

For patients hospitalized with respiratory illness, rapid testing for influenza clearly influences antimicrobial prescribing decisions, but test results for other viruses have less impact, a study conducted over three winters in a large Montreal hospital suggests.

In the prospective study, described yesterday in the Journal of Infectious Diseases, 800 patients admitted to the hospital with respiratory illness were tested for 12 viruses, including flu. The authors hypothesized that positive flu tests would lead to appropriate antiviral therapy and decreased use of antibiotics, and that positivity for other viruses would lead to stopping oseltamivir and antibiotics.

Most of the patients were started on antibiotic treatment before they were tested for viruses. Flu was identified in 53% of the patients, and other viruses were found in 10%. In patients not already on oseltamivir treatment, clinicians were nine times more likely to start oseltamivir if they tested positive for flu than if they tested negative, and flu positivity was associated with shorter hospital stays.

Patients who were started on antibiotics before the viral testing and then had a positive flu test were roughly 1.4 times more likely to have their antibiotics discontinued than were those who tested negative, but the association was not statistically significant after adjusting for potential confounders such as age and comorbidity, the authors said.

Antibiotic management was most significantly correlated with radiologic suspicion of pneumonia—even though radiologic findings don't reliably distinguish between bacterial and viral pneumonia—and was less correlated with the viral test results, the authors found. "Positivity for other viruses was not correlated with significantly different outcomes."

"Merely providing access to rapid multiplex testing may not be sufficient to reduce antibiotics, even during winter when influenza and other viral pathogens are frequent," the report concludes. "The ability to interpret positive results in the context of clinical illness, and the legitimate concerns of bacterial co-infections need to be addressed."
Jun 19 J Infect Dis abstract


Survey gauges physician support for penalizing inappropriate prescribing

Originally published by CIDRAP News Jun 20

A Web-based survey of members of the American College of Physicians indicates that clinicians are more likely to support financial penalties for routine antibiotic prescribing when presented with information about patient harms.

In the survey, published today in the Annals of Internal Medicine, physicians were presented with a clinical vignette to measure how likely they were to recommend antibiotics for uncomplicated upper respiratory infection. They were also asked about their attitudes regarding cost control in patient care.

The physicians were randomly assigned to one of four versions of the principal question, which evaluated how likely they were to support a policy that financially penalized physicians and organizations for routinely prescribing antibiotics for such infections. The first version described the harm to patients from routine antibiotic prescribing (increased costs, iatrogenic infections), the second version described the harms to society (increased antibiotic resistance, diversion of limited healthcare resources to less productive uses), the third described increased costs to institutions (hospitals and insurers), and the fourth version described no harms.

The first three versions included the statement "According to research and expert opinion, mild to moderate upper respiratory symptoms lasting less than 7 days are frequently due to viruses and therefore resolve on their own."

Of 694 eligible respondents, 47% completed the survey. The mean age of the respondents was 48 years, 55% were male, and 90% were practicing physicians. Overall, 31% supported financial penalties, but that number rose to 41% among those assigned the patient harm version, compared with 36% assigned the institutional harm version, 23% of those assigned the societal harm version, and 25% of those given the control version. Support for financial penalties was also higher among physicians who agreed that clinicians should play an active role in cost control (31%) than among those who disagreed (14%).

The authors of the survey say the preliminary results suggest that emphasizing the harms and costs to patients could increase the acceptability of financial penalties for routine antibiotic prescribing.
Jun 20 Ann Intern Med survey


CDC: US Candida auris cases rise to 86

Originally published by CIDRAP News Jun 20

In its latest update on infections involving Candida auris, an emerging multidrug-resistant fungus, the CDC said it has received reports of 9 more illnesses, raising the total to 86.

One of the new cases is in Florida, raising the number of affected states to eight. That case involved a C auris sample that was collected in April. According to the CDC update, posted Jun 16, New Jersey and New York both have new cases with positive samples collected in May.

In a May 18 Morbidity and Mortality Weekly report on 77 cases, the CDC said many of the patients had epidemiologic connections and that many in the two hardest-hit states—New York and New Jersey—had overlapping stays at connected long-term care facilities and hospitals. New York now has 60 cases and New Jersey 17, according to the update. No other state has more than 4 cases.

C auris was first identified in 2009 in Japan and has emerged as a global health threat because of its growing resistance to all three major classes of antifungals used to treat Candidainfections. The CDC estimates the mortality rate of C auris infections at approximately 60%.
Jun 16 CDC Candida auris page
May 18 CIDRAP News scan


Meta-analysis finds self-medication a 'massive' problem in Middle East

Originally published by CIDRAP News Jun 20

Self-medication, including with antibiotics, is a major problem in the Middle East, a new review of 72 studies has found.

As noted in the Pharmacology Research & Perspectives meta-analysis, investigators identified research published from 1990 through 2015. Misused medicines included codeine-containing products, topical analgesics and corticosteroids, antimalarial drugs, and antibiotics. Self-medication was widespread, and pharmacists, friends, and parents were the main sources of drugs.

One study determined that in Syria 87% of 200 pharmacies agreed to sell antibiotics without a prescription. The figure increased to 97% when those seeking the drugs insisted. Another study found that pharmacies in Iran sold 57% of prescription items without a prescription. In Saudi Arabia, only one pharmacist refused to dispense medications without a prescription.

"There has been relatively little systematic research on this topic, partly due to the perception that self-medication misuse is not as problematic as other types of drug abuse," said lead author Malak Khalifeh, in a news release from Wiley, the journal's publisher. "This review has found a massive problem."
Jun 18 Pharmacol Res Perspect review
Jun 19 Wiley news release


OpGen's gene-profile antibiotic resistance testing advances

Originally published by CIDRAP News Jun 20

OpGen, Inc., of Gaithersburg, Md., yesterday announced it has entered into an agreement to use Thermo Fisher Scientific's technology to support the commercialization of its rapid molecular products and informatics system to help combat multidrug-resistant infections.

OpGen will combine Thermo Fisher's real-time polymerase chain reaction (PCR) testing with its genomic analysis and bioinformatics technology to help healthcare providers rapidly identify antibiotic susceptibility in bacteria by using resistance gene profiles.

Under the agreement, OpGen will commercialize the Acuitas Rapid Test for Pathogen ID and resistance genes on Thermo Fisher's new mid-throughput real-time PCR system. The effort will be supported by local labs that will interpret results using customized analysis software and OpGen's database to match genomic analysis data with antibiotic susceptibility information to identify microbial infections in individual patients.
Jun 19 OpGen press release 


Study finds low compliance with surgical antibiotic prophylaxis guidance

Originally published by CIDRAP News Jun 19

Only 10% of surgical procedures in Brazil involved full compliance with surgical antibiotic prophylaxis (SAP) guidelines, according to a new study in the American Journal of Infection Control.

The researchers analyzed data on 1,011 neurosurgical procedures in nine hospitals in 2010, including 451 craniotomies (44.6%), 325 spinal fusions (32.1%), 196 laminectomies (19.4%), and 39 other procedures (3.9%).

They found full compliance with SAP guidelines in only 10.0% of the procedures. Indication for an antibiotic was correct in 90.0% of procedures, and the dosage was accurate in 90.6%. Drug type, however, was compliant in only 64.2% of the cases. The investigators also found compliance 77.1% of the time for time for initiating SAP but only 26.1% compliance in duration of SAP.

Timing of SAP was too early in 7.3% of cases and too late in 15.6%. SAP duration was too short 11.7% of the time and too long 62.2% of the time.

The authors concluded, "Targeted training programs need to be developed to ensure dissemination of guidelines among surgeons. Monitoring, feedback, and closer interaction between the infection control personnel and the surgical team are key factors for better compliance rates of SAP."
Jun 16 Am J Infect Control study


Screening for MRSA not tied to prolonged vancomycin use

Originally published by CIDRAP News Jun 19

Screening patients for nasal colonization for MRSA does not appear to prolong vancomycin use, according to a retrospective cohort study in the American Journal of Infection Control.

Boston University researchers assessed 2,910 patients who were administered intravenous vancomycin in the VA Boston Healthcare System from January 2013 through November 2015. They found that testing positive for MRSA was tied to an almost triple rate of vancomycin use for more than 3 days. After the team controlled for clinical culture results, they found that MRSA colonization upon admission was not associated with vancomycin use for longer than 3 days. And a negative MRSA nasal swab on admission was tied to a high negative predictive value for all MRSA infections.

The investigators concluded, "Admission surveillance for MRSA nasal colonization is not a major driver of prolonged vancomycin use. A negative admission MRSA nasal screen may be a useful tool for antimicrobial stewardship programs to limit vancomycin use, particularly in noncritically ill patients."
Jun 16 Am J Infect Control findings


US data show most patients wrongly given antibiotics for conjunctivitis

Originally published by CIDRAP News Jun 19

Data from a large US study published in Ophthalmology revealed that 58% of people who have acute conjunctivitis ("pink eye") are wrongly prescribed antibiotics.

The study included data on 340,372 enrollees in a nationwide managed care network who had acute conjunctivitis. The authors noted that 198,462 of them (58.3%) filled one or more topical antibiotic prescriptions, and 38,774 (11.4%) filled prescriptions for antibiotic-corticosteroid combination products. Neither medication is indicated for the condition, and the combination products can in fact worsen the infection and are contra-indicated.

The scientists also found that more affluent and educated patients were more likely to fill an antibiotic prescription, as were patients of optometrists compared with those seeing an ophthalmologist. Patients first diagnosed by an urgent care physician, internist, pediatrician, or family physician were even more likely to fill a prescription for antibiotics.

Acute conjunctivitis can be caused by viruses, bacteria, or allergies, and even  bacterial infections typically resolve when left untreated. Antibiotics are rarely necessary.

"This study opens the lid on overprescribing of antibiotics for a common eye infection," said lead author Nakul S. Shekhawat, MD, MPH, in a press release from the American Academy of Ophthalmology (AAO), which publishes the journal. "It shows that current treatment decisions for pink eye are not based on evidence."

The study authors conclude in their paper, "These potentially harmful practices may prolong infection duration, may promote antibiotic resistance, and increase costs."
Jun 14 Ophthalmol study
Jun 19 AAO news release

In related news, the Pan American Health Organization (PAHO) late last week published an alert on increased conjunctivitis cases in five nations: the Bahamas, Brazil, Dominican Republic, Guadeloupe, and Martinique.

Four of the five countries reported fewer than 1,000 new cases, but the Dominican Republic has had 66,126 cases so far this year, PAHO said. That represents a 62% increase compared with the same time in 2016. "Outbreaks of conjunctivitis in other countries of the Region are under investigation," the agency reported.
Jun 16 PAHO update

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