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In vitro synergy of natamycin and voriconazole against clinical isolates of Fusarium, Candida, Aspergillus and Curvularia spp
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  • Published on:
    Combination therapy for Fungal keratitis: Should we go for it?
    • Purushothama M Rajkumar, Consultant, Department of Cornea and refractive services Aravind eye hospital and post graduate institute of ophthalmology, Pondicherry
    • Other Contributors:
      • Josephine S Christy, Consultant, Department of Cornea and refractive services

    We read with interest the report by Sradhanjali et al(1) demonstrating more effective antifungal activity of combination of Natamycin and voriconazole than single-use in vitro treatment. It should be noted, however, that given the small sample size, these results should be confirmed with a larger dataset.

    Caution should be exercised when inferring results from in vitro studies because it always do not translate to in vivo models and are inconsistent. In our hands, we found treatment success when adding topical voriconazole 1% with natamycin 5% in recalcitrant full thickness infiltrate cases of fungal keratitis. This may be because topical natamycin acts superficially whereas voriconazole, though not as effective as Natamycin, takes care of the deeper infiltration because it has better penetration than Natamycin. Sharma et al (2) also concluded that topical voriconazole seems to be a useful adjunct to natamycin in fungal keratitis not responding to topical natamycin. Debridement of ulcer also helps in these cases giving way for the drug to act and reducing the fungal load.

    Given the poor susceptibility and clinical outcomes among Fusarium ulcers treated with voriconazole, Sun et al(3) recommended against using voriconazole as a first-line therapy for Fusarium keratitis. Li et al(4) recommends against combination therapy because of possible interactions in mechanism of drugs. We believe that combination therapy as a first line of treatment may compound the pr...

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    Conflict of Interest:
    None declared.