Clinical translation of recommendations from randomised trials for management of herpes simplex keratitis.

Maria Cabrera-Aguas

Meeting:  2015 RANZCO


Date:      -

Session Title: Cornea Rapid Fire

Session Time:      -

Purpose: Herpes Simplex Keratitis (HSK) management is based on recommendations from clinical trials conducted in USA in the 1990s. This study aimed to identify current prescribing trends for HSK at Sydney Eye Hospital, and to compare these with guidelines in the literature.

Method: A retrospective case series was conducted to identify all HSK cases from January 2012 to December 2013. Cases were identified from viral swab results, pharmacy records, and ICD-10 coding data.

Results: 228 (82%) and 51 cases (18%) received antivirals for therapeutic and prophylactic indications, respectively. Regarding therapeutic indications, 117 cases (51%) were for epithelial HSK; 95 (81%) of whom were prescribed topical aciclovir five times daily. Another 16 cases (14%) received oral valaciclovir with doses ranging 500 to 1000mg, 1-3 times daily due to co-existent stromal or endothelial keratitis, or for co-existent herpetic keratouveitis, corneal graft or recurrent HSK.

Stromal, endothelial or herpetic keratouveitis was identified in 78 (34%) cases; 53 (68%) of whom received oral valaciclovir, ranging †500 to 1000mg, 2-3 times daily; another 6 (8%) received oral aciclovir ranging 200 to 400mg, 2-5 times daily, and 19 (24%) were prescribed topical aciclovir. In addition, 54 cases (69%) were prescribed a topical steroid.

Regarding prophylactic indications, 41 cases (84%) received oral valaciclovir 500mg, 1-2 times daily, while 8 cases (16%) received aciclovir 400mg, 1-3 times daily.


We identified great variation in antiviral prescribing patterns for HSK, a significant proportion of which fell outside recommended dosages. This has implications for treatment efficacy, toxicity, and economic wastage.