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Opinions of the Fourth-Generation Fluroroquinolones in
the Management of Bacterial Keratitis: A Survey of
Ophthalmologists from Four States
This study was supported in part by Research to Prevent Blindness (RPB), Inc.
Financial Disclosures:
Hugo Y. Hsu None
Heidi A. Israel None
Randall Nacke None
Jonathan C. Song None
Sonia H. Yoo Alcon, AMO, Carl Zeiss Meditect
Eduardo C. Alfonso None
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Background
• Over the past 20 years, empiric therapy with commercially-available antibiotics has come to replace fortified antibiotics as the drugs of choice in the treatment of the majority of bacterial keratitis.
• The 1990’s saw the introduction of the fluoroquinolones for ophthalmic use with studies suggesting equal efficacy when compared to fortified antibiotics.
• The newest “generation” of fluoroquinolones– moxifloxacine & gatifloxacine–were introduced in 2003 for ophthalmic use.
• While officially approved for the treatment of bacterial keratitis, the newer fluoroquinolones have become popular replacements for their older cousins in the treatment of bacterial keratitis.
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Purpose• To evaluate ophthalmologists’ opinions
of the newer fluoroquinolone antibiotics in the management of bacterial keratitis.
• 6100 anonymous practice-pattern questionnaires were sent to ophthalmologists in California, Florida, Illinois, & Missouri
• The questionnaires were grouped and filtered by the type and setting of the respondents’ practices
• Descriptive statistics, chi-square, & non-parametric analysis techniques were employed.
Methods
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Methods: Questions asked
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Results
• 629 surveys were returned (10.3%)
Comprehensive 475 (75.5%)Cornea 100 (15.9%)Retina 45 (7.2%)Refractive 58 (9.2%)Glaucoma 52 (8.3%)Peds/Strabismus
40 (6.4%)
Others 31 (4.9%)Total 629*
* Respondents were allowed to indicate more than one choice to describe the nature of their practice
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“Overall, has the introduction of the 4th generation fluoroquinoones (Vigamox® & Zymar®) impacted your practice and your usage of antibiotics?”
Comprehensive practices
Cornea practices
P-value
“not really” 35 (8.5%) 9 (9.2%)
0.334
“a little bit” 107 (25.8%) 30 (30.6%)
“definitely” 272 (65.7%) 59 (60.2%)
Total 414 98
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“4th generation fluoroquinolones make me < fill in the blank > to culture a patient with a corneal ulcer.”
Comprehensive practices
Cornea practices
P-value
“more likely”
9 (2.2%) 3 (3.0%)
< 0.001
“no change”
195 (47.3%) 67 (67.7%)
“less likely” 208 (50.5%) 29 (29.3%)
Total 412 99
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“4th generation fluoroquinolones make me < fill in the blank > to refer a patient with a corneal ulcer.”
Comprehensive practices
Cornea practices
P-value
“more likely”
3 (0.7%) 0
< 0.001
“no change”
219 (53.0%) 78 (79.6%)
“less likely” 191 (46.2%) 20 (20.4%)
Total 413 98
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“4th generation fluoroquinolones represent a significant improvement over prior fluoroquinolons in the treatment of corneal ulcers.”
Comprehensive practices
Cornea practices
P-value
“don’t agree” 35 (8.5%) 13 (13.1%)
0.122
“somewhat agree”
138 (33.3%) 37 (37.4%)
“mostly agree”
141 (34.1%) 28 (28.3%)
“strongly agree”
100 (24.2%) 21 (21.2%)
Total 414 99
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Is there a difference between cornea specialists in private vs. academic
practices?
P-value
“…has the 4th generation fluoroquinolones impacted your practice and usage of antibiotics?”
0.55
“4th generation…make me < fill in > culture a patient”
0.08
“4th generation…make me < fill in > refer a patient”
0.22
“4th generation…represent a significant improvement…” (degrees of agreement)
0.90
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Conclusion
• The newer fluoroquinolones have impacted the practices of and the usage of antibiotics among ophthalmologists.
• Slightly over half of ophthalmologists surveyed indicate that the newer fluoroquinolones are an improvement over their older cousins in the management of corneal ulcers.
• These impacts and impression are more strongly felt by comprehensive ophthalmologists than cornea specialists.
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Conclusion
• Specifically, while having similar opinions, fewer cornea specialists have changed their management of corneal ulcers compared to their comprehensive colleagues due to the newer fluoroquinolones.
• No difference(s) were found in the answers between private cornea specialists and academic cornea specialists.