Ciprofloxacin-resistant pseudomonas keratitis1☆,
Section snippets
Materials and methods
Medical and microbiology records of culture-proven cases of Pseudomonas keratitis examined at the L.V. Prasad Eye Institute, Hyderabad, India, between January 1991 and June 1998 were reviewed retrospectively.
As a routine, corneal scrapings were obtained from all cases of corneal ulcer with a sterile No. 15 blade on a Bard Parker handle. Material obtained from the base and edges of the ulcer was subjected to microscopic evaluation and inoculated on various solid and liquid media that facilitate
Results
A total of 141 culture-proven cases of Pseudomonas keratitis were treated at the L.V. Prasad Eye Institute between January 1991 and June 1998. From the results of the in vitro antimicrobial susceptibility test (Kirby-Bauer disk-diffusion method), we identified 22 (15.6%) cases of keratitis caused by ciprofloxacin-resistant Pseudomonas. The clinical details of these patients are given in Table 1. The ages of the patients ranged between 10 and 55 years (mean = 32 years). The male-to-female ratio
Discussion
Bacterial infection of the cornea is a threat to vision. Even less severe forms require urgent treatment, and the more severe forms constitute ocular emergencies and require immediate therapy with an effective antimicrobial agent. Because the specific etiologic organism and its antimicrobial susceptibility are not known initially, an agent with a broad spectrum of antibacterial coverage is needed. However, only a limited number of broad-spectrum antibiotics are commercially available for
Conclusion
Although the infecting organisms are different, this series and others5, 16, 17 clearly suggest that, despite the difficulty in interpreting in vitro antimicrobial susceptibility tests and their uncertain relationship to topical antibiotic treatment, ciprofloxacin resistance is a real phenomenon in ophthalmic practice. Therefore, empirical treatment of bacterial keratitis with ciprofloxacin monotherapy requires a critical review at this time.
Corneal cultures must be obtained before antibiotic
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Supported by the Hyderabad Eye Research Foundation, Hyderabad, India.
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The authors have no proprietary interest in any of the products mentioned in this article.