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Study of the First Contact Management Profile of Cases of Infectious Keratitis: A Hospital-Based Study

Vajpayee, R. B. M.B.B.S., M.S.; Dada, Tanuj M.D.; Saxena, Rohit M.B.B.S.; Vajpayee, Madhu M.D.; Taylor, Hugh R. M.D.; Venkatesh, Pradeep M.D.; Sharma, Namrata M.D.

Clinical Sciences

Purpose. To study the management pattern and examine the role of cultures and antibiotic sensitivity testing in infectious keratitis.

Methods. A retrospective analysis of the demographic, clinical, and microbiological data was performed in 100 consecutive patients with infectious keratitis. The main parameters evaluated were nature of first contact with the health care services, investigations undertaken, treatment initiated, and the time interval between presentation to the first medical contact and to our center. Finally, the reports of culture and antibiotic sensitivity testing undertaken at our center were evaluated.

Results. In 70% of cases, ophthalmologists in independent practice were the first medical contact. Direct microscopy of the corneal scraping was undertaken in only 6% of cases, whereas culture and sensitivity studies had not been performed in any of the patients. Forty-six percent of the patients were prescribed 0.3% ciprofloxacin eyedrops in an inadequate dosage. Broad-spectrum fortified antibiotics eye drops had not been prescribed in any of the cases. At our center, positive cultures were obtained in 73.86% of cases and the most common organism isolated was coagulase-negative Staphylococcus (33.84%), followed by Pseudomonas aeruginosa (15.38%). A large number of the isolates demonstrated resistance to the recommended antibiotic therapy.

Conclusions. Failure to implement standard management protocol for infectious keratitis at first contact is a major factor contributing to ocular morbidity in India.

From Dr. Rajendra Prasad Centre for Ophthalmic Sciences (R.B.V., T.D., R.S., P.V., N.S.), Department of Microbiology (M.V.), All India Institute of Medical Sciences, New Delhi, India; Centre for Eye Research Australia (H.R.T.), University of Melbourne, Melbourne, Australia.

Manuscript submitted February 12, 1999.

Accepted March 10, 1999.

Address correspondence and reprint requests to Dr. R.B. Vajpayee, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences Campus, New Delhi 110029, India. E-mail: rbvajpay@medinst.ernet.in

© 2000 Lippincott Williams & Wilkins, Inc.