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Maria A Woodward, Dena Ballouz, Josh Errickson, Nenita Maganti, Megan Tuohy; Medication burden for patients with bacterial keratitis. Invest. Ophthalmol. Vis. Sci. 2019;60(9):841. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Bacterial keratitis requires frequent dosing of costly medications. Patients often incur high costs, and affordability may impact compliance. We performed a retrospective case series to quantify the medication and treatment requirements for patients with bacterial keratitis.
Retrospective case series of encounters of adult patients in an academic ophthalmology practice at a large tertiary care referral center with clinical diagnosis of bacterial keratitis was performed. The primary outcome was medication burden, as determined by the number of visits, total doses prescribed, number of unique medications, length of treatment, maximum daily dose, and average doses per day. Medication cost was estimated using average wholesale pharmacy price. Linear regression analysis was performed on outcomes to examine associations with patient demographics and corneal culturing results.
48 patients (56% female) met enrollment criteria. Patients were treated for a median of 54 days, had 10 visits, were prescribed 5 unique medications, and administered 587 drops. They filled 7 prescriptions for medications. Estimated median medication cost was $933 (25% and 75% Interquartile ranges: $457-1422) dollars. Patients with positive bacterial scrapings had the most visits, most total doses, most unique drugs, and longest course of treatment, with lesser values observed in patients with no bacterial growth and the lowest with no scraping performed. Compared to no scraping, positive bacterial growth was predictive of more visits (b: 6.16, 95% CI: 1.75-10.6, p=0.007), more days of treatment (b: 86.8, 95% CI: 10.8-163, p=0.026), more prescribed medications (b: 2.86, 95% CI: 1.04-4.67, p=0.003), and more doses of medications (b: 796, 95% CI: 818-1,412, p=0.012). For every 10 year increment of age, patients were prescribed 132 more drops of medication (b: 132, 95% CI: 18.2-246, p=0.024). Gender or income did not predict treatment burden.
Patients with bacterial keratitis have substantial medication burden, particularly older patients and those with positive corneal cultures. Approaches to lower medication burden should be addressed, perhaps by novel methods to rapidly diagnosis disease or to tailor treatments to the individual patient.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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