Topical ciprofloxacin for treating nontuberculous mycobacterial keratitis

Abstract

This study aimed to evaluate the clinical efficacy of topical ciprofloxacin for treating Mycobacterium fortuitum and Mycobacterium chelonae keratitis refractory to amikacin therapy. A prospective clinical trial of topical ciprofloxacin treatment for nontuberculous mycobacterial keratitis was conducted. Eleven patients with nontuberculous mycobacterial keratitis diagnosed from 1992 to 1996 were enrolled. All 11 patients were treated initially with topical fortified amikacin, but only 2 patients responded. The other nine patients, four with M. fortuitum and five with M. chelonae keratitis, were refractory to amikacin therapy and received topical ciprofloxacin treatment. Bacterial culture and drug susceptibility tests using the broth microdilution method were performed on all 11 patients. The clinical response to amikacin or ciprofloxacin treatment was judged by corneal re-epithelialization and density and/or size of corneal infiltrates. M. chelonae isolates were more resistant to amikacin and ciprofloxacin than M. fortuitum isolates based on the in vitro susceptibility test. Clinically, three patients with M. fortuitum keratitis were responsive to ciprofloxacin therapy; however, only one patient with M. chelonae keratitis responded to the same therapy. Topical ciprofloxacin offers a therapeutic alternative for nontuberculous mycobacterial keratitis, which was refractory to amikacin treatment. However, topical ciprofloxacin was more effective for treating M. fortuitum keratitis than for M. chelonae keratitis.