In vitro susceptibility of bacterial keratitis pathogens to ciprofloxacin: Emerging resistance1☆,
Section snippets
Materials and methods
A retrospective review of a corneal ulcer database at the LV Prasad Eye Institute in Hyderabad, India, identified 1633 bacterial isolates from 1353 patients of culture-proven bacterial keratitis seen between March 1, 1991, and June 30, 1997.
Corneal scrapings were obtained using a sterile Bard Parker blade (#15) and were inoculated directly onto sheep blood agar, chocolate agar, thioglycolate, and brain heart infusion broth. These media were incubated at 37° C. Blood agar plates were incubated
Results
A total of 1558 bacterial isolates from 1303 patients were examined in this series. Gram-positive cocci accounted for 1091 (70%) of all bacterial isolates, gram-positive bacilli for 20 (1.3%), gram-negative organisms for 165 (10.6%), and Actinomycetes and related organisms for 282 (18.1%).
Of the 1558 isolates, 478 (30.7%) were not sensitive to ciprofloxacin (defined as either resistant [R] or intermediate sensitivity [I] by the Kirby-Bauer disc diffusion method). One or more
Discussion
Control of fulminant forms of bacterial keratitis requires potent antimicrobial agents. Until recent years, the concentration of commercially available antibiotics was inadequate to control such infections, necessitating the usage of fortified antibiotics. More recently, the use of ocular ciprofloxacin as monotherapy for bacterial keratitis has been discussed.1, 2, 3, 4, 5, 9, 10 Greater efficacy, low ocular toxicity, and dispensing convenience have made it a reasonable alternative to
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2013, OphthalmologyCitation Excerpt :It has been demonstrated amply in the available randomized clinical trials that topical corticosteroids may not help in enhancing the rate of healing in cases of resolving keratitis.33,34 The argument against fluoroquinolone monotherapy is that although these agents are considered very effective and safe, resistance is bound to occur if they are used indiscriminately, and a few cases of moxifloxacin and gatifloxacin resistance already are emerging, especially in cases of infectious keratitis occurring after refractive surgery35–40; however, their judicious use in an appropriate setting may be justified. Furthermore, poor patients from rural areas often are uneducated and have poor access to tertiary care hospitals or pharmacy.
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Supported by Hyderabad Eye Research Foundation.
- 1
The authors have no proprietary interest in any aspect of this study.
- 2
Derek Y. Kunimoto is on a fellowship from Harvard Medical School, Department of Ophthalmology.