Parenteral aminoglycoside therapy for bacterial keratitis.

Abstract

<h3>In Reply.</h3> —We have shown that the concentration of aminoglycosides achieved in the tears after systemic administration is far below any therapeutic level necessary to obtain high corneal level in the treatment of bacterial keratitis. Although our subjects were free of any ocular disease, which may be a drawback of our study, additional experimental evidence has shown that intramuscular therapy with tobramycin or gentamicin sulfate is no more effective than saline in treating keratitis in rabbits and that topical administration alone is consistently superior to more systemic routes of administration.^1,2 Our experience continues to support the effectiveness of fortified antibiotics administered topically for the treatment of central bacterial keratitis. If topical therapy is not available or must be delayed, then antibiotic therapy may be started with a subconjunctival injection that has been shown to achieve high corneal levels, at least in a six-hour trial. Antibiotics administered intravenously or intra