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B. S. Hochstetler, I. U. Scott, D. Liang, J. Shaw; Current Trends in the Management of Bacterial Keratitis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2881.
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To report current trends in the initial management of corneal ulcers by comprehensive ophthalmologists in the United States (US).
Ophthalmologists in the US were selected randomly from the American Academy of Ophthalmology Member Directory 2008 if their practice type was listed as "comprehensive" and they listed an email address as a form of contact. An email provided a hyperlink to the survey website and invited the members to participate anonymously. The survey collected basic demographic and practice information and presented initial management options for three brief clinical cases of bacterial keratitis of varying degrees of severity (minor, moderate and severe).
One thousand thirteen email invitations were delivered and 152 respondents participated in the survey for a response rate of 15%. Immediate referral to a cornea specialist was chosen as initial management by 9.8% of ophthalmologists for a minor ulcer, 54% for a moderate severity ulcer and 68% for a severe central ulcer. Microbiologic cultures were obtained by 17%, 82% and 87% of ophthalmologists for minor, moderate and severe ulcers, respectively. Third or fourth generation fluoroquinolones were used as initial antibiotic treatment, as single agent or combination therapy, by 92%, 76%, and 62% of ophthalmologists for minor, moderate and severe ulcers, respectively. Fortified antibiotics were used more often as initial treatment with increasing severity of ulcers.
Comprehensive ophthalmologists demonstrated a high rate of obtaining microbiologic cultures prior to initiating treatment for bacterial keratitis. The rates found through this survey are significantly higher than those in previous reports. The results of the current study indicate that newer generation fluoroquinolones are a mainstay of treatment for bacterial keratitis of any severity. This high rate of usage reflects the efficacy of these agents, but may have implications for future patterns of bacterial resistance.
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