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

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.