Treatment Of Bacterial Corneal Ulcers Research Articles

Susceptibility pattern of bacterial isolates in equine ulcerative keratitis: Implications for empirical treatment at a university teaching hospital in Sydney.

Corneal ulceration is a common ophthalmic condition in horses. It is frequently caused by trauma to the corneal surface, followed by secondary infection by commensal or pathogenic organisms including Streptococcus equi subspecies zooepidemicus, Pseudomonas aeruginosa and Staphylococcus spp. Emerging antimicrobial resistance amongst these organisms has raised the need for appropriate antimicrobial therapy selection, to optimise treatment efficacy while minimising further antimicrobial resistance. Medical records of 38 horses presented at the University Veterinary Teaching Hospital Camden for ulcerative keratitis between 2010 and 2020 were reviewed to identify those with positive bacterial cultures and antimicrobial susceptibility profiles (13/38). Common susceptibility patterns were identified and used to guide the empirical treatment of equine bacterial corneal ulcers. Pseudomonas spp. (64.3%), Streptococcus equi subspecies zooepidemicus (14.3%) and Actinobacillus spp. (14.3%) were most commonly identified. Susceptibility to amikacin, gentamicin and ciprofloxacin was observed in 100%, 66.7% and 85.7% Pseudomonas spp. isolates respectively. Resistance to polymyxin B and neomycin occurred in 85.7% and 71.4% of Pseudomonas spp., respectively. All Streptococcus equi subspecies zooepidemicus organisms in this study were susceptible to ceftiofur, cephalexin, penicillin and ampicillin, while they were all resistant to gentamicin, neomycin, enrofloxacin and marbofloxacin. Predominating in this study, Pseudomonas spp. maintained overall aminoglycoside susceptibility despite some emerging resistance, and good fluoroquinolone susceptibility. High resistance to Polymyxin B could have arisen from its common use as first-line therapy for bacterial corneal ulcers. Although further research is required, these new findings about predominant bacteria in equine corneal ulceration in the Camden region and their antimicrobial susceptibility patterns can be used to guide the empirical treatment of bacterial corneal ulcers in horses.

Bacterial corneal ulcers in pediatric patients. Algorithms of pharmacotherapy. Part II

Part I of the article presents a review of publications highlighting current exogenous and endogenous risk factors contributing to the occurrence of bacterial corneal ulcers, laboratory diagnostic methods, clinical differential diagnostic features of bacterial corneal ulcers.
 A wide variety of objective symptoms characterizes the clinical picture of bacterial corneal ulcers. Still, objective differential diagnostic signs make it possible with a high degree of probability to assume the etiology of the disease during the first biomicroscopy and immediately begin etiotropic therapy, on the timing of which the outcome of the disease depends.
 Standard laboratory examination of patients with bacterial corneal ulcers includes the bacterioscopic and cultural examination of the contents of the conjunctival sac. However, the absence of etiotropic therapy while waiting for the results of microbiological research methods, which takes from 3 to 7 days, contributes to the rapid progression of the disease, the development of endophthalmitis, and corneal perforation, up to the loss of an eye in children. In this regard, treatment must be started immediately. Therefore, the choice of a drug is determined not only by the causative agent, proven laboratory but, first of all, based on clinical differential diagnostic signs of the disease.
 The traditional, undeniable approach to the conservative treatment of bacterial corneal ulcers is conventional etiotropic therapy using local and systemic antibacterial drugs. In addition, timely intensive specific drug therapy prevents the destruction of all layers of the cornea, and the use of metabolic drugs that improve regeneration and trophism promotes epithelialization of corneal ulcers.
 Attention should be given to the necessity and validity of the choice of antibacterial drugs for various etiological forms of bacterial corneal ulcers in children. An individual approach is a basis for effective antibiotic therapy in pediatric ophthalmology.
 The article presents an up-to-date review of publications and modern algorithms for treating bacterial corneal ulcers in children, the main causative agents of which are: Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Neisseria gonorrhoeae.

Complex Approach to the Bacterial Corneal Ulcers Treatment

Purpose: Objective: to evaluate the effect of treatment of bacterial corneal ulcers of varying severity using a combination of antibacterial and corticosteroid drugs.Material and methods. 63 patients with bacterial corneal ulcers of varying severity were treated. The study used a quantitative scale to assess the severity of corneal ulcers. Group 1 — patients with mild corneal ulcers (18 patients); Group 2 — patients with moderate corneal ulcer (17 patients); group 3 — severe corneal ulcer (11 patients); control group — patients with mild corneal ulcer (17 patients). Patients of groups 1, 2 and 3, in addition to the conventional treatment, received Dexamethasone 0.1 % — 0.3 ml in parabulbar injections from the first day of treatment for the entire treatment period. Kr). In addition to the standard ophthalmological examination, all patients were assessed for the ulcer defect using measurements on OCT-POG accessing the parameters of the diameter of the corneal ulcer (d) and the depth coefficient (Kr).Results. The patients in the 1st group received antibacterial treatment and the addition of parabulbar injections of a corticosteroid drug (Dexamethasone). It allowed to decrease the treatment time and the period of hospitalization, promoted faster epithelialization and a reduction in the depth of the ulcer, less coarse scarring of the cornea, allowed to increase the functional results of treatment. The proposed treatment for severe corneal ulcers in 55 % of cases allows to use only conservative treatment. It is possible to obtain moderate opacity with vascularization in 60 % cases, which contributes to the preservation and/or improvement of visual acuity, despite the severity of the inflammatory process without the use of surgical intervention.Conclusion. The proposed treatment, involving the use of the corticosteroid drug Dexamethasone 0.1 % in parabulbar injections of 0.3 ml once daily for a bacterial corneal ulcer of mild severity for, average, 15.0 ± 1.4 days, a bacterial corneal ulcer of moderate severity — 18.0 ± 1.3 days, severe bacterial corneal ulcer — 25.0 ± 4.4 days, seems to be effective if the proposed parameters of the diameter and depth of the corneal ulcer are controlled.

Ефективність використання аутологічної сироватки крові у комплексному лікуванні бактеріальних виразок рогівки у хворих на цукровий діабет

Ефективність використання аутологічної сироватки крові у комплексному лікуванні бактеріальних виразок рогівки у хворих на цукровий діабет

OUR EXPERIENCE OF USING AUTOLOGICAL BLOOD SERUM IN COMPLEX TREATMENT OF BACTERIAL CORNEAL ULCERS IN PATIENTS WITH DIABETES MELLITUS DEPENDING ON THESEVERETY OF DIABETIC POLYNEUROPATHY

Summary. Diabetic keratopathy, which develops against the background of diabetic corneal neuropathyshould be taken into account when choosing tactics for the treatment of bacterial corneal ulcers in patients with diabetes mellitus.
 The aim of the study was to determine the effectiveness of treatment of bacterial corneal ulcers with the help of additional local use of autological serum eye drops in patients with type 1 diabetes depending on the severity of diabetic polyneuropathy (DPN).
 Materials and methods. The results of observation of 10 patients (10 eyes) with bacterial corneal ulcer and type 1 diabetes mellitus, in which delayed healing of corneal ulcer defect were noted and the absence of microorganisms ware confirmed by repeated bacteriological examinations of corneal smears and scrapings,were analyzed. In addition to standard therapy, all patients 2 weeks after the start of treatment were additionally prescribed eye drops with autologous serum. Patients were divided into 2 groups according to the stage of severity of DPN: the first group consisted of 5 patients with symptomatic stage, the second - 5 patients with a stage of severe complications. In addition to standard, ophthalmic examination methods included bacteriological examination, fluorescein test, OCT of the anterior segment of the eye on the device TOPCON 3D OCT-2000, non-contact examination of corneal sensitivity.
 Results and discussion. It was found that the threshold of corneal sensitivity in patients with bacterial corneal ulcer at the stage of severe complications of DPN was higher than that in symptomatic DPN by an average of 16.6 % during the observation. The degree of pericorneal injection and infiltration of the cornea, as well as the size and depth of the ulcerative defect of the cornea at the stage of severe complications exceeded the corresponding indicators of patients with symptomatic DPN during the observation. Normalization of conjunctival color and reepithelialization of the cornea in all patients with severe complications occurred 3 days later than in patients with symptomatic DPN.
 Conclusions. The course of bacterial keratitis in patients with diabetes mellitus depends on the severity of DPN: a pronounced violation of corneal innervation at the stage of severe complications of DPN, manifested by a decrease in its sensitivity, leads to prolongation of treatment, even with additional use of eye drops with autologous serum.

The Steroids for Corneal Ulcers Trial

To provide comprehensive trial methods and baseline data for the Steroids for Corneal Ulcers Trial and to present epidemiological characteristics such as risk factors, causative organisms, and ulcer severity. Baseline data from a 1:1 randomized, placebo-controlled, double-masked clinical trial comparing prednisolone phosphate, 1%, with placebo as adjunctive therapy for the treatment of bacterial corneal ulcers. Eligible patients had a culture-positive bacterial corneal ulcer and had been taking moxifloxacin for 48 hours. The primary outcome for the trial is best spectacle-corrected visual acuity at 3 months from enrollment. This report provides comprehensive baseline data, including best spectacle-corrected visual acuity, infiltrate size, microbiological results, and patient demographics, for patients enrolled in the trial. Of 500 patients enrolled, 97% were in India. Two hundred twenty patients (44%) were agricultural workers. Median baseline visual acuity was 0.84 logMAR (Snellen, 20/125) (interquartile range, 0.36-1.7; Snellen, 20/50 to counting fingers). Baseline visual acuity was not significantly different between the United States and India. Ulcers in India had larger infiltrate/scar sizes (P = .04) and deeper infiltrates (P = .04) and were more likely to be localized centrally (P = .002) than ulcers enrolled in the United States. Gram-positive bacteria were the most common organisms isolated from the ulcers (n = 366, 72%). The Steroids for Corneal Ulcers Trial will compare the use of a topical corticosteroid with placebo as adjunctive therapy for bacterial corneal ulcers. Patients enrolled in this trial had diverse ulcer severity and on average significantly reduced visual acuity at presentation. clinicaltrials.gov Identifier: NCT00324168.

Corticosteroids for Bacterial Keratitis

To determine whether there is a benefit in clinical outcomes with the use of topical corticosteroids as adjunctive therapy in the treatment of bacterial corneal ulcers. Randomized, placebo-controlled, double-masked, multicenter clinical trial comparing prednisolone sodium phosphate, 1.0%, to placebo as adjunctive therapy for the treatment of bacterial corneal ulcers. Eligible patients had a culture-positive bacterial corneal ulcer and received topical moxifloxacin for at least 48 hours before randomization. The primary outcome was best spectacle-corrected visual acuity (BSCVA) at 3 months from enrollment. Secondary outcomes included infiltrate/scar size, reepithelialization, and corneal perforation. Between September 1, 2006, and February 22, 2010, 1769 patients were screened for the trial and 500 patients were enrolled. No significant difference was observed in the 3-month BSCVA (-0.009 logarithm of the minimum angle of resolution [logMAR]; 95% CI, -0.085 to 0.068; P = .82), infiltrate/scar size (P = .40), time to reepithelialization (P = .44), or corneal perforation (P > .99). A significant effect of corticosteroids was observed in subgroups of baseline BSCVA (P = .03) and ulcer location (P = .04). At 3 months, patients with vision of counting fingers or worse at baseline had 0.17 logMAR better visual acuity with corticosteroids (95% CI, -0.31 to -0.02; P = .03) compared with placebo, and patients with ulcers that were completely central at baseline had 0.20 logMAR better visual acuity with corticosteroids (-0.37 to -0.04; P = .02). We found no overall difference in 3-month BSCVA and no safety concerns with adjunctive corticosteroid therapy for bacterial corneal ulcers. Adjunctive topical corticosteroid use does not improve 3-month vision in patients with bacterial corneal ulcers. clinicaltrials.gov Identifier: NCT00324168.

Randomized Clinical Study for Comparative Evaluation of Fourth-Generation Fluoroquinolones With the Combination of Fortified Antibiotics in the Treatment of Bacterial Corneal Ulcers

Comparative evaluation of efficacy of monotherapy with moxifloxacin (0.5%) or gatifloxacin (0.3%) with combination therapy of cefazolin (5%) and tobramycin (1.3%) in treatment of bacterial corneal ulcers. Patients diagnosed with bacterial keratitis (ulcer diameter 2-8 mm) were randomized to 1 of the 3 treatment groups (tobramycin 1.3% and cefazolin 5%, gatifloxacin 0.3%, or moxifloxacin 0.5%). After obtaining corneal scrapings, assigned study medication was instilled hourly for 48 hours and tapered as per clinical response. Healing of ulcer, duration to cure, adverse reactions, antibiogram profile, treatment failures, final visual acuity, and corneal opacity size were evaluated. A total of 61 patients were enrolled [cefazolin and tobramycin (n = 20), gatifloxacin (n = 21), and moxifloxacin (n = 20)]. Overall, 57 patients (93%) healed on treatment. On comparison of the mean time taken to heal, no statistically significant difference was found among all the 3 treatment groups (P = 0.98). Positive bacterial culture was obtained in only 38 patients (62%). There was no significant difference in the bacterial isolates in each treatment group. There were 4 (7%) treatment failures (perforation or nonhealing ulcer): 1 (5%) each in moxifloxacin and gatifloxacin group and 2 (10%) in fortified antibiotics group. All regimens were well tolerated. The study failed to find a difference in the efficacy of monotherapy with fourth-generation fluoroquinolones in the treatment of bacterial corneal ulcers of 2-8 mm size when compared with combination therapy of fortified antibiotics.

Comparison of topical fixed-combination fortified vancomycin–amikacin (VA solution) to conventional separate therapy in the treatment of bacterial corneal ulcer

In an in vitro study, fixed-combination fortified vancomycin and amikacin ophthalmic solutions (VA solution) had the same potency and stable physical properties as the separate components. In this retrospective clinical study, we evaluated the efficacy of the topical VA solution in the treatment of bacterial corneal ulcer and comparison with separate topical fortified vancomycin and amikacin. Separate topical fortified eye drops was used prior to January 2004 and switched to the VA solution afterwards in the treatment of bacterial corneal ulcer. The medical records of 223 patients diagnosed with bacterial corneal ulcers between January 2002 and December 2005 were reviewed retrospectively. There were 122 patients in the VA group and 101 in the separate group. Cure was defined as complete healing of the ulcer accompanied by a nonprogressive stromal infiltrate on two consecutive visits. No significant difference was found between the VA and separate therapy group. The mean treatment duration was 15.4 days in the VA group and 16.1 days in the separate therapy group. The average hospital stay was 5.4 days (VA) and 7.2 days (separate antibiotics). Stromal infiltration regressed significantly without further expansion in both groups. All corneal ulcers completely re-epithelialized without complications related to drugs. VA solution provided similar efficacy to the conventional separate therapy in the treatment of bacterial corneal ulcers; however, it is more convenient and tolerable, promotes patient's compliance, avoids the washout effect, and reduces nurse utilization. Hence, VA solution is a good alternative to separate therapy.

Fluoroquinolone and fortified antibiotics for treating bacterial corneal ulcers

AIMTo compare the clinical efficacy of commercially available fluoroquinolone drops with the use of combined fortified antibiotics (tobramycin 1.3%-cefazolin 5%) in treatment of bacterial corneal ulcer.METHODSThe medical records of 140...

Comparison of Ciprofloxacin Ophthalmic Solution 0.3% to Fortified Tobramycin-Cefazolin in Treating Bacterial Corneal Ulcers

The purpose of the study is to compare the clinical efficacy and safety of ciprofloxacin ophthalmic solution 0.3% (Ciloxan) with a standard therapy regimen (fortified tobramycin, 1.3%-cefazolin, 5.0%) for treating bacterial corneal ulcers. This randomized, parallel group, double-masked, multicenter study was conducted in 324 patients at 28 centers in the United States, Europe, and India. Patients were randomized into 2 treatment groups: 160 to ciprofloxacin and 164 to fortified tobramycin-cefazolin. Positive microbiologic cultures were obtained in 188 (58%) of 324 patients. Of these, 176 patients met protocol criteria and were evaluated for treatment efficacy: 82 in the ciprofloxacin group and 94 in the standard therapy group. The dosing schedule for both treatment groups was 1 to 2 drops of the first study medication (ciprofloxacin or fortified tobramycin) every 30 minutes for 6 hours, then hourly for the remainder of day 1; 1 to 2 drops every hour on days 2 and 3; 1 to 2 drops every 2 hours on days 4 and 5, followed by 1 to 2 drops every 4 hours on days 6 to 14. The second medication (ciprofloxacin or cefazolin) was instilled 5 to 15 minutes after the first drug, following the same dosing frequency. Physician's judgment of clinical success, cure rate, changes in ocular sings, and symptoms and the rate of treatment failures were the primary efficacy criteria. Topical ciprofloxacin monotherapy is equivalent clinically and statistically to the standard therapy regimen of fortified antibiotics. No statistically significant treatment differences were found between ciprofloxacin (91.5%) and standard therapy (86.2%) in terms of overall clinical efficacy (P = 0.34). Similarly, no differences were noted in resolution of the clinical signs and symptoms (P > 0.08) or the time to cure (P = 0.55). The incidence of treatment failures was less in the ciprofloxacin group (8.5%) compared with the standard therapy group (13.8%). Significantly fewer patients treated with ciprofloxacin reported discomfort than did patients treated with the standard therapy regimen (P = 0.01). Ciprofloxacin ophthalmic solution 0.3% monotherapy is equivalent clinically and statistically to standard therapy (fortified tobramycin-cefazolin) for the treatment of bacterial corneal ulcers and produces significantly less discomfort.

Topical vs Subconjunctival Treatment of Bacterial Corneal Ulcers

The efficacy of eye drops and subconjunctival injections in the treatment of bacterial corneal ulcers for each of the following combinations were compared: cefazolin for staphylococcal ulcers, gentamicin for staphylococcal ulcers, and gentamicin for pseudomonal ulcers. Topical and subconjunctival therapy were equally effective in reducing the numbers of viable bacteria in experimental corneal ulcers. Subconjunctival injections produced high but transient peaks followed by persistent low troughs. In contrast, eye drops produced moderate but sustained concentrations throughout the treatment period. Under the conditions of this study, it appears that transient high peaks are not needed to eliminate bacteria effectively from a corneal ulcer. Since eye drops and subconjunctival injections are equally effective, other factors should determine the preferred route or routes of therapy.