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Keratitis
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Bacterial keratitis can be treated with hourly topical eyedrops with quinolones or aminoglycosides and review after 48 hours. Dual therapy with fortified cephalosporin (5% cefuroxime or cefazolin 50 mg/mL) with gentamicin is also effective but less well tolerated.
Corneal Ulcers and Contact Lens Keratitis
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
General principles: The majority of bacterial keratitis with small infiltrates or peripheral location can be managed with empiric therapy using commercial, broad-spectrum topical antibiotics. Central or large corneal infiltrates extending to the deep stroma need corneal scraping for microbiological culture and specific topical antibiotic therapy. Hospital admission should be considered if the patients are unlikely to comply with treatment, especially intensive treatment in the initial few days. Later, if the ulcer becomes resistant to treatment, we must consider stopping all therapy and re-scraping the ulcer to look for any other organism. Some cases will benefit from use of amniotic membrane to enhance healing. In cases with progressive keratitis or impending perforation, a tectonic or therapeutic penetrating keratoplasty may be needed. Promotion of epithelial healing is important for a non-healing sterile ulcer and can be improved by debridement of necrotic corneal stroma, lubrication, and/or temporary tarsorrhaphy.
Moxifloxacin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Moxifloxacin was found to be clinically equivalent to ofloxacin (0.3%) and fortified tobramycin (1.33%)/cephazolin (5%) in a prospective randomized trial of 229 patients with bacterial keratitis. No statistically significant differences were noted between treatment groups for the healing rate, cure rate, or complications associated with any of the ophthalmic solutions (Constantinou et al., 2007). Similar findings were later reported by Sharma et al. (2013) in a randomized, controlled equivalence trial involving 224 patients with bacterial keratitis. Complete resolution of keratitis and associated ulcers was seen in 81.8% of those receiving topical moxifloxacin (0.5%) versus 81.4% in those receiving combination cefazolin (5%) and tobramycin (1.3%) therapy (Sharma et al., 2013). Burka and colleagues (Burka et al., 2005; Burka et al., 2006) demonstrated that moxifloxacin and gatifloxacin were equivalent when used postoperatively after photorefractive keratectomy. In this prospective randomized trial, 35 patients undergoing photorefractive keratectomy were randomized to either moxifloxacin 0.5% or gatifloxacin 0.3% ophthalmic drops four times daily for 1 week. At 6 weeks, eyes treated with moxifloxacin healed faster and had smaller defects than those treated with gatifloxacin, but there were no significant differences in visual outcomes with either antibiotic.
Intrastromal Administration of Vancomycin to Maximize Its Early Effect on Methicillin-resistant Staphylococcus Aureus Keratitis: A Rabbit Study
Published in Ocular Immunology and Inflammation, 2022
Ahmet Yucel Ucgul, Rukiye Kilic Ucgul, Mustafa Behcet
Bacterial keratitis is one of the most common causes of corneal blindness worldwide.1 The occurrence of bacterial keratitis is commonly associated with predisposing factors such as improper care of contact lenses, eyelid and lacrimal disorders, corneal abrasions, and previous corneal surgeries.2 Gram-positive organisms, especially methicillin-resistant Staphylococcus aureus (MRSA), are the highest causative agents of bacterial keratitis.2 Early and effective treatment of MRSA keratitis is of great importance because the clinical course can progress rapidly to corneal perforation and even endophthalmitis with a delay in treatment.3 Consequently, penetrating keratoplasty, tectonic or therapeutic, may be necessary for the treatment of keratitis and to restore the integrity of the globe.4
Current understanding and therapeutic management of contact lens associated sterile corneal infiltrates and microbial keratitis
Published in Clinical and Experimental Optometry, 2021
Lily Ho, Isabelle Jalbert, Kathleen Watt, Alex Hui
The Massachusetts Eye and Ear implemented the 1-2-3-ACT (Assessment, Culture, Treatment) algorithm,79 which is an adaptation from Vital et al.77 This algorithm outlined the treatment pathway, including when smears and cultures should be performed.79 It highlighted any ulcer with potentially sight-threatening characteristics should be cultured, as well as ulcer with ‘ ≥2 adjacent lesions’ to capture atypical bacterial, fungal, and Acanthamoeba infections.79 Managing practitioners are recommended to consider any additional portentous clinical signs or patient history as indications. The Bacterial Keratitis Preferred Practice Pattern published by the American Academy of Ophthalmology outlines its own recommendation for smears and cultures.80Table 479,80 has combined these criteria. Microbiological testing is warranted if any one of the criteria is met and should be performed for patients before initiating antimicrobial therapy.
Levofloxacin-loaded naturally occurring monoterpene-based nanoemulgel: a feasible efficient system to circumvent MRSA ocular infections
Published in Drug Development and Industrial Pharmacy, 2020
Mohammed M. Mehanna, Amina Tarek Mneimneh, Khaled Abed El Jalil
Bacterial keratitis is a very common infection, leading to serious complications like corneal damage, loss of vision, or complete blindness if adequate treatment wasn’t initiated on time [8]. Corneal infections are complications of extended wearing of contact lenses, scleral buckles, sutures, and glaucoma tubes. According to microbiologists, pathogens always form biofilms on these surfaces, which make bacterial eradication difficult due to biofilm drug resistance [9]. Staphylococcus aureus is a leading cause of keratitis worldwide, it is the most virulent Staphylococcus species owing to many factors, including improved host adhesion and cytolytic activity, and immune system evasion [10]. Rise of MRSA strains has brought about the necessity to develop new antimicrobials for bacterial keratitis management.