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Medication Burden for Patients With Bacterial Keratitis

Ballouz, Dena BS*; Maganti, Nenita BS*,†; Tuohy, Megan MD*; Errickson, Josh PhD; Woodward, Maria A. MD, MSc*,§

doi: 10.1097/ICO.0000000000001942
Clinical Science

Purpose: To understand medication use and patient burden for treatment of bacterial keratitis (BK).

Methods: A retrospective study was conducted examining medical records of adult patients with BK in an academic cornea practice. Data collected included medications used in the treatment of BK, dosing of medications, and the number and total duration of clinical encounters. Costs of medications were estimated using the average wholesale pharmacy price. Linear regression analysis was used to investigate associations of medication use with patient demographics and corneal culture results and reported with beta estimates (β) and 95% confidence intervals (95% CIs).

Results: Forty-eight patients with BK (56% female) were studied. Patients were treated for a median of 54 days with 10 visits, 5 unique medications, 587 drops, and 7 prescriptions. The estimated median medication cost was $933 (interquartile range: $457–$1422) US dollars. Positive bacterial growth was significantly associated with more visits (β: 6.16, 95% CI: 1.75–10.6, P = 0.007), more days of treatment (β: 86.8, 95% CI: 10.8–163, P = 0.026), more prescribed medications (β: 2.86, 95% CI: 1.04–4.67, P = 0.003), and more doses of medications (β: 796, 95% CI: 818–1412, P = 0.012) compared with patients who did not undergo corneal scraping. Patients were prescribed 132 more drops of medication for every 10 years of older age (β: 132, 95% CI: 18.2–246, P = 0.024). Sex and income were not associated with medication burden or treatment length.

Conclusions: Older patients and those with positive cultures incur the most medication burden in treatment of BK. Providers should be aware of medication usage and cost burden as it may affect compliance with treatment.

*Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI;

Feinberg School of Medicine, Northwestern University, Chicago, IL;

Consulting for Statistics, Computing and Analytics Research (CSCAR), University of Michigan, Ann Arbor, MI; and

§Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.

Correspondence: Maria A. Woodward, MD, MSc, Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, 1000 Wall St, Ann Arbor, MI 48105 (e-mail:

Supported by the National Institutes of Health K23 EY023596 (M. A. Woodward), Rockville, MD.

The authors have no conflicts of interest to disclose.

M. A. Woodward had full access to the data and takes responsibility for the integrity and accuracy of the data analysis.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The funding organization had no role in the study design or conduct, data collection, management, analysis, interpretation of the data, decision to publish, or preparation of the manuscript.

Received December 26, 2018

Received in revised form February 12, 2019

Accepted February 17, 2019

Online date: April 4, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.