Background: Over-prescription of antibiotics for common infective conditions is an important and ongoing public health issue. Infective conjunctivitis represents one of the most common eye-related complaints in general practice. Despite its self-limiting nature, there is evidence of frequent GP antibiotic prescribing for this condition, which is inconsistent with evidence-based guidelines.
Method: A cross-sectional analysis of the Registrars Encounters in Clinical Training (ReCEnT) ongoing prospective cohort study, which documents GP registrars clinical consultations. The outcome of the analyses was antibiotic prescription for a new diagnosis of conjunctivitis. Patient, registrar, practice and consultation variables were included in univariate and multivariable logistic regression analyses to test associations of these prescriptions.
Results: 2,333 registrars participated in 18 data collection rounds from 2010-2018. There were 1,580 new cases of infective conjunctivitis (0.31% of all problems). Antibiotics (mainly topical) were prescribed in 1,170 (74%) of these cases, with chloramphenicol being the most common. Variables associated with antibiotic prescription included patient Aboriginal and/or Torres Strait Islander status (OR=17.6), registrar organisation of a follow-up (OR = 1.42) and earlier registrar training term (more junior status) (OR=0.68 (registrar being in later training term).
Discussion: GP registrars, like established GPs, prescribe antibiotics for conjunctivitis in excess of guideline recommendations, but prescribing rates are lower in later training terms. Despite stable patterns of antibiotic resistance, these excessive prescribing patterns have important social, economic and educational ramifications.
Implications for practice: To our knowledge, this is the first study internationally to analyse the frequency and associations of antibiotic prescribing by GP trainees for conjunctivitis. This research serves to inform educational strategies to promote rational antibiotic prescribing for GPs and registrars, and has broader implications on a public health and community level given the over the counter availability of topical antibiotic agents.