Microbial Keratitis in Thailand: A Survey of Common Practice Patterns(cid:31)
Napaporn Tananuvat MD*, Mallika Suwanniponth MD*
Affiliation : (cid:31) The authors have no proprietary interest in the products named in this article, Presented in part at the Royal College of Ophthalmology of Thailand Meeting in November 2006 * Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai
Objective : To describe the current practice patterns and prescription preferences in treating microbial keratitis
in Thailand.
Material and Method: 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 com-
bined 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 differ-
ently, 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.
Keywords : Microbial keratitis, Corneal ulcer, Fungal keratitis, Survey, Practice patterns
