Article Text

Download PDFPDF
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}lvpei.org

Abstract

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

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.