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Keratitis
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Treatment of Acanthamoeba keratitis is mainly aimed at killing the amoebic cysts as opposed to the more sensitive trophozoites and consists of eye drops with two or three agents: Chlorhexidine 0.02%–0.06%Polyhexanide or polyhexamethylene biguanide (PHMB) 0,02% (most effective against the cysts)Propamidine isethionate (Brolene) of hexamidine
Corneal Ulcers and Contact Lens Keratitis
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Acanthamoeba keratitis: If there is some doubt about whether the causative organism is bacterial or protozoal it is much safer to treat as for acanthamoeba than the reverse. Intensive treatment depending on clinical suspicion and local protocols with either: Polyhexamethylene biguanide (PHMB) 0.02% with either hexamidine 0.1% or propamidine 0.1% (Brolene®)orChlorhexidine digluconate (0.02%) and hexamidine 0.1% or propamidine 0.1% (Brolene®)
Therapeutic Approach in Fungal Keratitis
Published in Mahendra Rai, Marcelo Luís Occhiutto, Mycotic Keratitis, 2019
Victoria Díaz-Tome, María Teresa-Rodríguez Ares, Rubén Varela-Fernández, Rosario Touriño-Peralba, Miguel González-Barcia, Laura Martínez-Pérez, María Jesús Lamas, Francisco J. Otero-Espinar, Anxo Fernández-Ferreiro
Polyhexamethylene biguanide (PHMB), also known as polyhexanide, polyaminopropyl biguanide, polymeric biguanide hydrochloride or polyhexanide biguanide, is an antiseptic with antiviral and antibacterial properties used as an alternative for fungal keratitis treatment. It also shows a broad viricide and antifungal spectrum and has amoebicidal activity. Certainly, its antimicrobial efficacy has been demonstrated on Acanthamoeba polyphaga, A. castellanii, and A. hatchetti (Asiedu-Gyekye et al. 2015) by using 0.02 to 0.053% solutions without causing side effects.
Research progress on detachable microneedles for advanced applications
Published in Expert Opinion on Drug Delivery, 2022
SeungHyun Park, KangJu Lee, WonHyoung Ryu
Polyhexamethylene biguanide (PHMB), which has a large Mw (~1600 Da), is a drug used to treat acanthamoeba keratitis (AK), usually administered as an eyedrop to the corneal tissue. Because of its high solubility in water, it can be easily contained in drug-loaded MN comprising hydrophilic polymers. Sustained drug delivery in the posterior segment of the eye is necessary for the treatment of AK. Repeated topical application of eyedrops for achieving this often fails to heal because of the decrease in patient compliance. Lee et al. developed a multi-layered DeMN system – a so-called detachable microneedle pen (d-MNP) – with a PLGA drug-loaded MN containing PHMB for corneal stromal injection [47]. The drug-loaded MN released the drug over 1 week in vitro and was delivered to the corneal tissue under optimized d-MNP injection conditions including injection dwell time and depth for clear detachment of the MN. Park et al. optimized the amount of PHMB in the drug-loaded MN for clinical usage [66] (Figure 5b). To investigate the efficacy of substituting the current PHMB eyedrops with the d-MNP, in vivo tests were performed with the AK mouse model, and the results with the d-MNP were compared to those obtained by applying eyedrops four times a day. The quantification of the clinical scoring system showed that the results of a single injection of the d-MNP were similar to those of the eyedrops after 6 d. It was demonstrated that the d-MNP could be used as a substitute for eyedrops in treating corneal disease with a single administration.
Systemic Miltefosine as an Adjunct Treatment of Progressive Acanthamoeba Keratitis
Published in Ocular Immunology and Inflammation, 2021
Andrea Naranjo, Jaime D. Martinez, Darlene Miller, Rahul Tonk, Guillermo Amescua
In vitro studies of MLT activity against Acanthamoeba have shown 100% eradication of the trophozoites and varying cysticidal activity; however, the required concentration of MLT to achieve this effect varies depending on the Acanthamoeba strain.17,18 Animal studies have demonstrated increased efficacy using topical MLT when compared to standard medical treatment as propamidine isethionate and polyhexanide19,20 and further determined that the best results were obtained when using a combination of polyhexamethylene biguanide plus MLT.20 Of note, animal models do not exhibit severe inflammation. However, a pilot study of topical MLT in vivo showed that topical MLT failed as monotherapy as all of the five patients included in the study had an increase in size and/or density of infiltrate after at least 1 week of treatment with MLT.1
Recent advancements in cellulose-based biomaterials for management of infected wounds
Published in Expert Opinion on Drug Delivery, 2021
Munira Momin, Varsha Mishra, Sankalp Gharat, Abdelwahab Omri
Several studies have documented the application of nanocellulose in wound healing. Some of the studies are described here. Nanocellulose was used to obtain bioactive wound dressing loaded with antimicrobials (tetracycline hydrochloride and polyhexamethylene biguanide) to prevent bacterial infection, especially Staphylococcus aureus and Escherichia coli infection [191]. Hydrogel preparation for many applications, such as tissue engineering scaffolds and wound dressing, as a drug delivery matrix has been reported using CNC and CNF [192]. A nanocellulose film coated with honey was developed for the management of chronic wounds. It exhibited significant antimicrobial activity on both Gram-positive and Gram-negative bacteria [193]. A nanocellulose composite dressing containing chitosan was successfully developed by Poonguzhali and team. In this study, it was concluded that the addition of nanocellulose enhanced the wound healing rate when compared with standard chitosan dressing [194]. Hemicellulose-reinforced nanocellulose hydrogels showed that it may be a promising scaffold for the application in wound healing as it promoted cell adhesion, cell growth, and proliferation [112]. The development of nanocellulose fibers and collagen matrix for wound healing and tissue regeneration has also shown promising results [195].