RT Journal Article
SR Electronic
T1 Leap forward in the treatment of <em>Pythium insidiosum</em> keratitis
JF British Journal of Ophthalmology
JO Br J Ophthalmol
FD BMJ Publishing Group Ltd.
SP 1629
OP 1633
DO 10.1136/bjophthalmol-2017-311360
VO 102
IS 12
A1 Bhupesh Bagga
A1 Savitri Sharma
A1 Sai Jeevan Madhuri Guda
A1 Ritu Nagpal
A1 Joveeta Joseph
A1 Kodiganti Manjulatha
A1 Ashik Mohamed
A1 Prashant Garg
YR 2018
UL http://bjo.bmj.com/content/102/12/1629.abstract
AB Background Pythium insidiosum is a parafungus that causes keratitis resembling fungal keratitis. This study compares outcome in a large cohort of patients with P insidiosum keratitis treated with antifungal drugs, to a pilot group treated with antibacterial antibiotics.Methods Between January 2014 and December 2016, 114 patients with culture positive P insidiosum keratitis were included in the study. A subset of culture isolates was tested in vitro for response to nine antibacterial antibiotics by disc diffusion and E test. Patients were treated with topical natamycin in 2014, 2015 and up until mid 2016. Thereafter, the patients received a combination of topical linezolid and topical and oral azithromycin. Therapeutic penetrating keratoplasty (TPK) was done for patients not responding to medical therapy.Results In vitro disc diffusion assay showed linezolid to be most effective. The rate of TPK was significantly higher in 2015 compared with 2016 (43/45, 95.6% vs 22/32, 68.8%; p=0.002). Eighteen patients were treated with antibacterial and 14 were treated with antifungal antibiotic in 2016. One patient was lost to follow-up in each group. The rate of TPK was higher and proportion of healed ulcers was lower (p=0.21, Fisher’s exact test) in the group on antifungal therapy (TPK—11/13, 84.6%; Healed—2/13, 15.3%) compared with the group on antibacterial therapy (TPK—11/17, 64.7%; Healed—6/17, 35.2%).Conclusions We report favourable but not statistically significant response of P insidiosum keratitis to antibacterial agents in a pilot series of patients. Further evaluation of this strategy in larger number of patients is recommended.