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    Better diagnosis, treatment options key to nonresponsive bacterial keratitis


    Click here to enlarge image. The bacterial species commonly isolated were Pseudomonas and Staphylococcus, with a wide variety of other gram positive and gram negative species. (Chart courtesy of Eduardo C. Alfonso, MD)

    Treatment options

    Looking at treatment, fluoroquinolones are the choice for bacterial keratitis, Dr. Alfonso said. However, aminoglycosides and fortified antibiotics also continue to play a role.

    A greater number of treatment options is valuable because research done at Bascom Palmer has found that when culturing patients on prior treatment, those on monotherapy were more likely to have gram-positive and gram-negative isolates. There was a higher incidence of cultural-positive results if two or three antibiotics were used.

    “There’s also a greater chance that the reason [the bacterial keratitis] didn’t respond is because it was a nonbacterial ulcer, most likely caused by fungi,” Dr. Alfonso said. “It needs to be pointed out that these are trends and are not statistically significant.”

    Commonly used treatments for bacterial keratitis are not always effective, he added.

    “Fluoroquinolones would not cover Staph aureus or Staph epidermis as well as gram-negative bacilli, Dr. Alfonso explained. “The aminoglycosides, like gentamycin and tobramycin, would not be adequate for Streptococcus, gram negative, or mycobacteria,”

    Vancomycin is often the treatment of choice for gram positives and cases of in vitro resistance. For mycobacteria, which is not seen that often, clarithromycin and amikacin are the drugs of choice, Dr. Alfonso said.

    Still, there are times in the clinical setting where a patient may still respond unexpectedly to certain antibiotics. Going forward, better identification of pathogens and newer treatment options may help patients with nonresponsive bacterial keratitis, Dr. Alfonso concluded.



    Eduardo C. Alfonso, MD

    E: [email protected]

    This article was adapted from a presentation that Dr. Alfonso delivered at the Cornea Subspecialty Day, held prior to the 2016 American Academy of Ophthalmology meeting. Dr. Alfonso has no related financial interests.

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