Abstract
Purpose. To report a case of microbial keratitis caused by Pseudomonas aeruginosa treated with a combination of acetazolamide and ceftazidime. Methods. Case report. Results. We report the case of a 17-year-old contact lens-wearing female who developed severe keratitis due to Pseudomonas aeruginosa temporarily healed with topical fortified antibiotic eye drops. After few days, the patient relapsed, and topical and intravenous ceftazidime were added. Concomitantly, oral administration of acetazolamide was prescribed. This carbonic anhydrase inhibitor was added to the antibiotic regimen in order to decrease the anterior chamber pH, and then, the ceftazidime ionization. By lowering the state of ionization of the antibiotic in the aqueous humor, its concentration was increased. This was confirmed by an improvement of the patient within few days and a rapid eradication of the infection. Conclusion. This is the first reported case of keratitis caused by P. aeruginosa successfully treated using acetazolamide as an enhancer of ceftazidime effectiveness.
Highlights
A 17-year-old woman was referred with a 48-hour history of a painful left eye as a consequence of a severe keratitis most likely of bacterial aetiology
On day 2, the bacterium was identified as Pseudomonas aeruginosa and antibiotic disc sensitivity testings revealed that the organism was sensitive to most of antibiotics including ticarcillin, amikacin, ciprofloxacin, and ceftazidime
Keratitis caused by Pseudomonas has been commonly associated with the wearing of soft contact lenses [2], and it has recently been reported that the wearing of contact lenses was the most common risk factor for keratitis and that the most commonly isolated organism was P. aeruginosa [3, 4]
Summary
We report the case of a 17-year-old contact lens-wearing female who developed severe keratitis due to Pseudomonas aeruginosa temporarily healed with topical fortified antibiotic eye drops. Ulcer size and hypopyon were reduced, and the patient was discharged from hospital but prescribed to continue the topical antibiotic treatment at home, every 4 hours. On day 16, due to the inefficacy of this treatment, corneal scrapings were performed again for bacterial culture and amoebic PCR, results of which were both negative. Three weeks after the start of the infection, the clinical situation was still worsening and the integrity of the eye was compromised (Figure 1) At this stage, a new therapeutic strategy was prescribed; topical and intravenous ceftazidime were included in the antimicrobial strategy.
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