Clinical translation of recommendations from randomized trials for management of herpes simplex virus keratitis

Abstract

Importance: To standardize initial anti-viral therapy for herpes simplex keratitis (HSK).

Background: To determine prescribing trends for the management of HSK and compare the trends to available clinical trial evidence.

Design: Retrospective review of patients at the Sydney Eye Hospital, Australia.

Participants: Three hundred and one eyes of 296 patients prescribed anti-virals for HSK aged 18 years and above, from 1 January 2012 to 31 December 2013.

Methods: Patients were identified from viral swab results, pharmacy records and International Classification of Diseases 10 (ICD-10) coding data.

Main outcome measure: Initial anti-viral therapy.

Results: Anti-viral therapy was given for therapeutic and prophylactic indications at presentation in 256 (85%) and 45 (15%) eyes, respectively. Overall, anti-virals prescribed included valaciclovir 500-1000 mg 1-3 times daily, aciclovir 200-400 mg 1-5 times daily, topical aciclovir 2-5 times daily and topical trifluorothymidine two hourly or as needed daily or combined oral and topical anti-virals. Indication and dose of prescribed anti-virals aligned with clinical evidence in 125 of 141 eyes (89%) with epithelial HSK, 2 of 22 eyes (9%) with stromal without ulceration HSK, 6 of 18 (28%) eyes with endothelial HSK and 31 of 45 (69%) eyes with HSK prophylaxis. Overall, 164 eyes (54%) received 'evidence-based' anti-viral therapy.

Conclusions and relevance: Prescribing patterns for anti-viral therapy to treat and prevent recurrence of HSK were diverse. Local guidelines are needed to standardize the indications and dose of initial anti-viral therapy for HSK. Implementation of these guidelines will likely improve patient care and rationalize the use of health resources.

Keywords: anti-virals; evidence-based medicine; herpes simplex virus; keratitis; therapy.