Survey of state conjunctivitis policies for school-age students

PURPOSE To examine state policies regarding school-age students with conjunctivitis. METHODS Analysis included the following evidence: publicly available policies for disposition of affected students; indications for exclusion and return to classroom; and completeness of information, including mention of different etiologies of conjunctivitis; signs and symptoms of viral versus bacterial conjunctivitis; student disposition and treatment based on etiology; internally consistent recommendations; reference to credible resources; and mention of the possibility of a conjunctivitis outbreak. RESULTS Fifteen of 50 states have no policies. Ten states allow students to remain in school, 5 allow return 24 hours after initiation of antibiotic treatment, and 5 require physician approval. Seventeen states and Washington, DC, offer little detail or internally inconsistent recommendations, such as choice of antibiotic use or provider note. Twelve policies are thoroughly presented. Twenty-three states refer to sources like the Centers for Disease Control and Prevention and the American Academy of Pediatrics. No policy references the American Academy of Ophthalmology. CONCLUSIONS State policies on conjunctivitis in students vary widely. Antibiotic use as a prerequisite for return to school has drawbacks of cost to parents, increasing antibiotic resistance, and lack of efficacy against nonbacterial etiologies, for example, viral conjunctivitis. Publicly available information and guidelines could be improved, aiming for fewer absentee days, reduced outbreak risk, and reduced risk of antibiotic resistance.