Fortified topical vancomycin drops in the treatment of bacterial keratitis

Abstract EN

Background : bacterial keratitis is among the most important external ocular surface diseases because of its associated serious morbidity.

Variable bacterial agents are implicated as causative agents and emerging bacterial resistance to the routinely used antibiotics should be always thought of.

The aim of this study is to evaluate the role of fortified vancomycin drops in managing bacterial microbial keratitis.

Patients and methods : thirty seven patients with bacterial microbial keratitis were included in this study,19 patients(Group A) received the empirical immunotherapy ; ciprofloxacin eye drops and 18 patients(Group B) received the empirical dual therapy ; fortified gentamicin plus cefuroxime eye drops.

Response to treatment was monitored and non-responding cases in the two groups received additional fortified vancomycin drops (50mg / ml).

Results : in group A, 14 patients (73.3 %) showed positive response to the empirical treatment within two days and 5 (26.3 %) did not.

In group B, 12 patients (66.7 %) responded well and 6 (33.3 %) did not.

The eleven non responding cases in both groups ; A and B, were given topical vancomycin drops (50mg / ml) as an additional antibiotic.

Eight of them (72.7 %) were labeled to be good responders within the first 24 hours.

The remaining three patients (27.3 %) were not and two of them (18.2 %) ended in vascularization and pacification of the cornea while the last one (9.1 %) developed corneal perforation.

Discussion and conclusion : topical fortified vancomycin shows positive additive effect when added to the empirical mono or dual therapy regimens we usually use in the treatment of bacterial keratitis .It saved two thirds of the resistant infected eyes with a more potent effect when combined with the dual therapy regimen (P value < 0.05).

Recommendations: In view of the wide spread, often unjustified, use of topical antibiotics in our society and the expected microbial resistance we recommend considering adding this medication to the empirical regimen of the dual therapy (gentamicin and cefuroxime) or immunotherapy (fluroquinolone) specially in cases of chronic ocular surface disease and chronic use of antibiotic drops.