Which statement about Trifluridine (Viroptic) dosing is accurate for dendritic keratitis?

• A. 3 times daily for 7 days
• B. 9 times daily initially, then 5 times daily after healing
• C. 1 drop every hour, then BID
• D. 2 times daily for 14 days

Answer: (B)

The key idea is that topical antiviral treatment for dendritic keratitis uses a high-frequency, intensive dosing at the start to aggressively suppress active viral replication, then is tapered to a lower frequency after the epithelium heals to maintain antiviral coverage while reducing drug toxicity.

Nine applications per day initially provide near-continuous drug exposure during the critical early period of active infection, helping to halt viral replication as the lesion begins to heal. Once healing has occurred, reducing to about five times daily maintains antiviral activity without the higher risk of irritation and toxicity associated with very frequent dosing.

Other regimens don’t match this balance. Dosing the drug only three times daily during the early phase would be insufficient to control the virus promptly. An hourly dose is overly burdensome and not the standard accepted pattern, and continuing only twice daily for the full course would fail to provide adequate suppression during active epithelial involvement.