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    Tracking the best treatment for fungal keratitis

    Studies favor natamycin, but more high-quality research needed on antifungal agents


    A study published by Dr. Garg and co-authors last year found similar trends favoring natamycin for filamentous fungal keratitis when compared with voriconazole 1%.2

    “In multivariate analysis, the effect of drug was marginal while the effect of age and epithelial defect was significant,” the authors wrote in their abstract. “In the group treated with natamycin, the final visual acuity was significantly better in patients with Fusarium keratitis but not with Aspergillus keratitis.”

    Voriconazole is also associated with more adverse effects, Dr. Garg said.

    Dr. Garg also noted that there have been lab studies to look at the in vitro susceptibility of filamentous fungi and candida. Lab data seem to favor natamycin as well, but amphotericin B also appeared promising in studies.

    However, when reviewing lab studies, clinicians should remember that those results do not necessarily translate into treatment outcomes.



    1. FlorCruz NV, Evans JR. Medical interventions for fungal keratitis. Cochrane Database Syst Rev. 2015;4:CD004241.

    2. Sharma S, Das S, Virdi A, et al. Re-appraisal of topical 1% voriconazole and 5% natamycin in the treatment of fungal keratitis in a randomised trial. Br J Opthalmol. 2015;99:1190-1195.



    Prashant Garg, MD

    E: [email protected]

    This article was adapted from Dr. Garg’s presentation at Cornea Subspecialty Day during the 2015 meeting of the American Academy of Ophthalmology. He did not indicate any proprietary interest in the subject matter.

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