Empirical or Culture-Guided Therapy for Microbial Keratitis? A Plea for Data

doi:10.1001/archopht.1996.01100130080013

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Vol. 114 No. 1, January 1996

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Empirical or Culture-Guided Therapy for Microbial Keratitis?

A Plea for Data

Peter J. McDonnell, MD

Arch Ophthalmol. 1996;114(1):84-87.

Abstract

In the United States, about 30 000 bacterial corneal ulcersare treated annually.¹ Compared with 100, or even 20, yearsago ophthalmologists today have available to them many diagnostictools (including special media and bacterial identificationtechniques), and an impressive assortment of antibiotics.^2-4Many reviews and book chapters describe the uses of microbiologicstudies—from Gram and Giemsa staining to media inoculationto immunofluorescence and even molecular genetics—to identifycausative organisms. This literature also describes the formulasfor preparation of highly concentrated, "fortified" antibioticsfor initial treatment of bacterial keratitis, until cultureand sensitivity results are available to guide modificationsin therapy. It would seem, therefore, that "experts" in thefield of corneal and external diseases have reached consensuson an appropriate initial microbiologic evaluation and treatmentof suspected microbial keratitis, and the large body of literatureon this topic might be considered to represent practice guidelines.It comes as a surprise to many that these published "guidelines"apparently are routinely ignored in current clinical practice.

Author Affiliations

From the Department of Ophthalmology, Doheny Eye Institute, Los Angeles, Calif.

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