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H. Y. Hsu, H. A. Israel, R. Nacke; Initial Choice and Opinion of Antibiotics for Corneal Ulcers: A Survey of Practicing Ophthalmologists. Invest. Ophthalmol. Vis. Sci. 2007;48(13):774.
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As is still taught in ophthalmology training programs, fortified antibiotics are the antibiotics or choice for the treatment of corneal ulcers. However, it has been well documented that the community standards of practice do not reflect this teaching. Therefore, we sought to evaluate the current choice and opinion of different classes of antibiotics and to determine whether the type of practice, training, experience, and practice-setting changes the choice and opinion.
An anonymous survey was mailed to all practicing ophthalmologists in the states of Illinois and Missouri as listed in the American Academy of Ophthalmology's member directory. The survey included questions on the type and setting of the clinical practice, fellowship training in cornea, prevalence of corneal ulcers in the practice, and practice patterns on corneal ulcer management and the role of different antibiotics. The survey results were analyzed to determine if the type of practice, cornea fellowship, practice setting, and frequency of corneal ulcers seen had significant bearings on the choice and opinion of antibiotics.
Approximately 15% of the surveys were returned. Self-described cornea practices were more likely to choose a fortified antibiotics over a fluoroquinolone than non-cornea practices (p = 0.00) and more likely to feel that fortified antibiotics were superior in the treatment of corneal ulcers (p = 0.05). Physicians with fellowship training in cornea/external diseases were more likely to prescribe a fortified antibiotic (p < 0.5) but did not necessarily feel that they were superior. Physicians in academic/university practice settings were more likely to choose a fortified antibiotic (p = 0.02) in the initial treatment of a corneal ulcer. Lastly, whereas practices that encounter corneal ulcers tend to choose 4th generation fluoroquinolones, those that see more than 6 ulcers a month tend to initiate fortified antibiotics (p < 0.01).
Fortified antibiotics remain the preferred means of treating a corneal ulcer in the minds of physicians who have a cornea practice, who practices in an academic/university setting, who have received cornea fellowship training, and who encounters > 6 ulcers a month. This contrasts with comprehensive ophthalmologists and ophthalmologists in non-academic practice settings where and for whom fluoroquinolones, especially the 4th generation, are the antibiotic of choice.
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