The value of fortified aminoglycoside/ cephalosporin treatment as first-line treatment and in fluoroquinolone-resistant bacterial keratitis

Abstract

Objectives: Topical application of fluoroquinolone antibiotics is thought to be as effective as fortified antibiotics. The aim of this study was to evaluate the efficacy of fluoroquinolones as an alternative to fortified antibiotic therapies. Materials and Methods: The medical records of 31 patients who were hospitalized in our department due to bacterial keratitis were retrospectively reviewed. Fluoroquinolone was started as the first treatment for 20 (64.5%) patients and upon no response fortified antibiotic was initiated, and 11 (35.5%) patients were started with fortified treatment. Cultures and smears were recorded before treatment. Lesions were evaluated as superficial or deep according to their depth. Treatment response was evaluated based on reduction of infiltrate depth and size, change in visual acuity, and regression of hypopyon. Results: Central, paracentral, and peripheral location were detected in 9 (29.0%), 10 (32.2%) and 12 (38.7%) eyes, respectively. According to lesion depth, 15 (48.3%) were deep and 16 (51.6%) were superficial. Response of superficial lesions was found to be statistically earlier (p=0.037). Culture was positive in 9 (29.0%) eyes. The initial best corrected visual acuity (BCVA) was 0.5±0.7 logMAR (-0.1-2.3) and 0.3±0.3 logMAR (-0.1-0.9) after treatment. Treatment response showed moderate but statistically nonsignificant correlation with time to treatment initiation and initial BCVA (r=0.527, p=0.184; r=0.517, p=0.120). Conclusion: Although fluoroquinolones are the first choice for the treatment of bacterial keratitis, fortified antibiotics have been shown to be effective in patients who do not respond to treatment. Fortified therapy should be kept in mind in the treatment of bacterial keratitis.