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Abstract

We agree it would be valuable to have a highly sensitive and specific point-of-care test to help differentiate viral from bacterial conjunctivitis. Similar tests have shown increasing value for guiding antibiotic use and patient management for other conditions, such as acute pharyngitis.1Lean W.L. Arnup S. Danchin M. et al.Rapid diagnostic tests for group A streptococcal pharyngitis: a meta-analysis.Pediatrics. 2014; 134: 771-781Crossref PubMed Scopus (106) Google Scholar However, suboptimal sensitivity can be a major impediment to clinical implementation, because clinicians can be reluctant to trust results from point-of-care testing, and/or the need for back up laboratory test confirmation continues.2Hardy V. Thompson M. Alto W. et al.Exploring the barriers and facilitators to use of point of care tests in family medicine clinics in the United States.BMC Fam Pract. 2016; 17: 149Crossref PubMed Scopus (29) Google Scholar We are aware of 3 diagnostic accuracy studies of the AdenoPlus point-of-care test. The study we cited in our editorial3Kam K.Y. Ong H.S. Bunce C. et al.Sensitivity and specificity of the AdenoPlus point-of-care system in detecting adenovirus in conjunctivitis patients at an ophthalmic emergency department: a diagnostic accuracy study.Br J Ophthalmol. 2015; 99: 1186-1189Crossref PubMed Scopus (31) Google Scholar found a sensitivity of 39.5% in a hospital eye emergency department, Sambursky et al4Sambursky R. Trattler W. Tauber S. et al.Sensitivity and specificity of the AdenoPlus test for diagnosing adenoviral conjunctivitis.JAMA Ophthalmol. 2013; 131: 17-22Crossref PubMed Scopus (39) Google Scholar found a much higher sensitivity of 85% to 90% (depending on the reference standard used) in ophthalmology private practices and academic centers, whereas Holtz et al5Holtz K.K. Townsend K.R. Furst J.W. et al.An assessment of the AdenoPlus point-of-care test for diagnosing adenoviral conjunctivitis and its effect on antibiotic stewardship.Mayo Clinic Proc: Innovations, Quality & Outcomes. 2017; 1: 170-175Abstract Full Text Full Text PDF Google Scholar found a sensitivity of 50% in acute eye care clinics. There are several reasons why diagnostic accuracy studies find differences in accuracy, including the population studied, prevalence of disease, as well as issues that may affect internal validity of a diagnostic accuracy estimate such as study design. However, based on current evidence, there seems to be insufficient data to recommend routine use of AdenoPlus in most settings. We encourage collaborative research involving the conduct of large, prospective studies to further inform this important area of clinical practice, including research generated in primary care and urgent care settings. Regarding how widely AdenoPlus is used currently for the diagnosis of conjunctivitis, we are not aware of any survey data, and suspect its use varies with clinical setting (primary vs specialty care). Anecdotal evidence, from the family medicine teaching sites in Washington, Wyoming, Alaska, Montana, and Idaho suggests its use is very low in primary care settings, which is where majority of the patients with conjunctivitis are seen. Re: Keen et al.: Treatment of acute conjunctivitis in the United States and evidence of antibiotic overuse: isolated issue or a systematic problem? (Ophthalmology. 2017;124:1096-1098)OphthalmologyVol. 125Issue 7PreviewWe are writing in response to the editorial by Keen and Thompson.1 This editorial describes the importance of limiting the antibiotic overtreatment of acute conjunctivitis and stresses the need for better antibiotic stewardship, especially because most cases are likely viral. The following 3 reasons were cited as the primary cause for unnecessary antibiotic use: (1) challenges of implementing best evidence into practice, especially primary care; (2) difficulty in clinically differentiating viral from bacterial conjunctivitis, leading practitioners to err toward antibiotic prescriptions; and (3) patient expectations and preferences driving the high prescription rates. Full-Text PDF