Microbial keratitis in Thailand: a survey of common practice patterns.
OBJECTIVE
To describe the current practice patterns and prescription preferences in treating microbial keratitis in Thailand.


METHODS
A questionnaire was designed and sent to ophthalmologists to describe their practice in patients with microbial keratitis. The questionnaire also presented two case scenarios with microbial keratitis; the less severe in the first patient and the more severe in the second. The recipients were asked about their diagnostic and therapeutic approaches. The surveys were mailed to 300 ophthalmologists around the country.


RESULTS
One hundred and forty-three surveys (48.6%) were used in the analysis. Over half the respondents (56%) would do corneal scraping for some patients with suspected microbial keratitis. Smears and cultures of corneal specimens are the most common diagnostic tools (92%) to identify the causative organisms. Of the respondents, 60% would treat Case 1 as an outpatient, compared with 90% would admit Case 2. About half the respondents (47%) would initiate treatment in Case 1 without obtaining scrapings, whereas 79% would prefer microbial work up in Case 2. Monotherapy with topical fluoroquinolone was the most common initial antibiotic prescribed for Case 1 (36%), whereas in Case 2, combined fortified antibiotics (23%) and combined topical antibiotic and topical antifungal (22%) were preferred. For fungal keratitis, topical natamycin and amphotericin B were the most common choices (20% each).


CONCLUSIONS
Most Thai ophthalmologists appear to treat patients with suspected microbial keratitis differently, depending on etiology and severity. However, there are some variations in management. The validity of this approach should be established to specify patterns that are most safe and effective.
Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand. ntananuv@mail.med.cmu.ac.th
Napaporn
N
Tananuvat
Mallika
M
Suwanniponth
D000293:Adolescent; D000328:Adult; D000617:Aminoglycosides / Q000627:therapeutic use; D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D002437:Cefazolin / Q000627:therapeutic use; D003625:Data Collection; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D007634:Keratitis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010866:Natamycin / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013785:Thailand
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D024841:Fluoroquinolones; D000666:Amphotericin B; D010866:Natamycin; D002437:Cefazolin