TY - JOUR
T1 - Community practice patterns for bacterial corneal ulcer evaluation and treatment
AU - Park, Jennifer
AU - Lee, Kim M.
AU - Zhou, Helen
AU - Rabin, Moriah
AU - Jwo, Kevin
AU - Burton, William B.
AU - Gritz, David C.
N1 - Publisher Copyright:
© 2013 Contact Lens Association of Ophthalmologists.
PY - 2015/1/13
Y1 - 2015/1/13
N2 - Objective: To examine current practice patterns in the management of bacterial keratitis among U.S. ophthalmologists and differences in the management and opinions between cornea specialists and non-cornea specialists. Methods: A questionnaire was distributed to randomly selected ophthalmologists in July 2011 using an online survey system. It inquired about the number of patients with corneal ulcers seen monthly, frequency of Gram staining and culturing corneal ulcers, maintenance of diagnostic supplies, opinions on when culturing is necessary for corneal ulcers, treatment preferences for different severities of bacterial corneal ulcers, and opinions regarding relative efficacy of fourth-generation fluoroquinolones and fortified broad-spectrum antibiotics. Results: One thousand seven hundred one surveys were distributed, and 486 (28.6%) surveys were returned. A minority of corneal ulcers was Gram stained (23.7%±34.1%, mean±SD) or cultured (35.1%±38.0%), but cornea specialists were more likely to perform both. The most popular antibiotic for the treatment of less severe ulcers was moxifloxacin (55.4%), and the most popular treatment of more severe ulcers was fortified broad-spectrum antibiotics (62.7%). Cornea specialists were significantly more likely than non-cornea specialists to prescribe fortified antibiotics for more severe corneal ulcers (78.1% vs. 53.7%, P<0.0001). A greater number of cornea specialists stated that fourth-generation fluoroquinolones were less effective than fortified antibiotics for the treatment of more severe corneal ulcers (79.6% of cornea specialists vs. 60.9% of non-cornea specialists, P<0.001). Conclusions: Cornea specialists and non-cornea specialists manage bacterial keratitis differently, with cornea specialists more likely to perform diagnostic testing and prescribe fortified broad-spectrum antibiotics for severe bacterial keratitis. Additional prospective studies demonstrating visual outcomes after differential treatment of bacterial keratitis are needed.
AB - Objective: To examine current practice patterns in the management of bacterial keratitis among U.S. ophthalmologists and differences in the management and opinions between cornea specialists and non-cornea specialists. Methods: A questionnaire was distributed to randomly selected ophthalmologists in July 2011 using an online survey system. It inquired about the number of patients with corneal ulcers seen monthly, frequency of Gram staining and culturing corneal ulcers, maintenance of diagnostic supplies, opinions on when culturing is necessary for corneal ulcers, treatment preferences for different severities of bacterial corneal ulcers, and opinions regarding relative efficacy of fourth-generation fluoroquinolones and fortified broad-spectrum antibiotics. Results: One thousand seven hundred one surveys were distributed, and 486 (28.6%) surveys were returned. A minority of corneal ulcers was Gram stained (23.7%±34.1%, mean±SD) or cultured (35.1%±38.0%), but cornea specialists were more likely to perform both. The most popular antibiotic for the treatment of less severe ulcers was moxifloxacin (55.4%), and the most popular treatment of more severe ulcers was fortified broad-spectrum antibiotics (62.7%). Cornea specialists were significantly more likely than non-cornea specialists to prescribe fortified antibiotics for more severe corneal ulcers (78.1% vs. 53.7%, P<0.0001). A greater number of cornea specialists stated that fourth-generation fluoroquinolones were less effective than fortified antibiotics for the treatment of more severe corneal ulcers (79.6% of cornea specialists vs. 60.9% of non-cornea specialists, P<0.001). Conclusions: Cornea specialists and non-cornea specialists manage bacterial keratitis differently, with cornea specialists more likely to perform diagnostic testing and prescribe fortified broad-spectrum antibiotics for severe bacterial keratitis. Additional prospective studies demonstrating visual outcomes after differential treatment of bacterial keratitis are needed.
KW - Bacterial keratitis
KW - Compounding pharmacy
KW - Corneal ulcer
KW - Fluoroquinolones
KW - Fortified antibiotics
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U2 - 10.1097/ICL.0000000000000059
DO - 10.1097/ICL.0000000000000059
M3 - Article
C2 - 25536529
AN - SCOPUS:84920837620
SN - 1542-2321
VL - 41
SP - 12
EP - 18
JO - Eye and Contact Lense
JF - Eye and Contact Lense
IS - 1
ER -