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Re-appraisal of topical 1% voriconazole and 5% natamycin in the treatment of fungal keratitis in a randomised trial
  1. Savitri Sharma1,2,
  2. Sujata Das1,
  3. Ajoy Virdi1,
  4. Merle Fernandes3,
  5. Srikant K Sahu1,
  6. Nagendra Kumar Koday3,
  7. Md Hasnat Ali2,
  8. Prashant Garg2,
  9. Swapna R Motukupally2
  1. 1L V Prasad Eye Institute, Bhubaneswar, Odisha, India
  2. 2L V Prasad Eye Institute, Brien Holden Eye Research Center, Hyderabad, Andhra Pradesh, India
  3. 3L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
  1. Correspondence to Dr Savitri Sharma, L V Prasad Eye Institute, KAR campus, Road No. 2, Banjara Hills, Hyderabad, AP 500034, India; savitri{at}


Purpose To compare the efficacy of topical 1% voriconazole vs 5% natamycin for the treatment of fungal keratitis.

Methods In a prospective, double-masked, randomised, controlled, registered clinical trial, 118 patients with fungal keratitis were treated using identical dosage schedule with either voriconazole (58) or natamycin (60) as inpatients for 7 days and followed up weekly. The outcome measures were percentage of patients with healed or resolving ulcer and final visual acuity at last follow-up (primary) and on day 7 (secondary) in each group.

Results More patients (p=0.005) on natamycin (50/56, 89.2%) had healed or resolving ulcer compared with voriconazole (34/51, 66.6%) at last follow-up. The improvement in vision was marginally greater in patients in the natamycin group compared with the voriconazole group at day 7 (p=0.04) and significantly greater at final visit (p=0.01). In univariate analysis, drug, age and mean size of corneal infiltrate and epithelial defect had a significant effect on the final visual outcome. In multivariate analysis, the effect of drug (voriconazole vs natamycin, adjusted coefficient 0.27 (−0.04 to 0.57), p=0.09) was marginal while the effect of age and epithelial defect was significant (p<0.001 for both). In the group treated with natamycin, the final visual acuity was significantly better (p=0.005, Wilcoxon signed-rank test) in patients with Fusarium keratitis but not with Aspergillus keratitis (p=0.714, paired t test).

Conclusions When compared with voriconazole, natamycin was more effective in the treatment of fungal keratitis, especially Fusarium keratitis.

Trial registration number: Clinical Trial Registry India (2010/091/003041).

  • Cornea
  • Drugs
  • Infection
  • Microbiology

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