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2011 OMIG Abstract 19

Natamycin in the treatment of fungal keratitis: Correlation of treatment outcome and
in vitro susceptibility of fungal isolates.

 S. Sharma1, L. Pradhan1, S. Nalamada2, S.K. Sahu1, S. Das (Glasg.)1, P. Garg2
1L.V. Prasad Eye Institute, Bhubaneswar, India, 2L.V. Prasad Eye Institute, Hyderabad, India

Purpose: To report the outcome of treatment with natamycin and its correlation with in vitro susceptibility of the fungal isolates to natamycin, in patients with fungal keratitis.

Methods: Laboratory proven fungal keratitis patients (divided into early and late cases) were treated with topical 5% natamycin and the treatment outcome at the end of four weeks was noted. Fungal isolates obtained from culture of corneal scrapings of these patients were tested for minimum inhibitory concentration of natamycin (mean MICn) by broth dilution method and the results were correlated. MICn of <16 μg/ml was considered sensitive.

Results: A total of 60 patients were included in the study. The mean MICn for various groups of fungi from patients with either early (<10 days) or late (>10 days) presentation was correlated with outcomes (Fisher’s exact). Aspergillus flavus showed the highest mean MICn (>16 μg/ml, resistance). While the clinical response in all patients with early A. flavus keratitis was good, it was poor in late cases (5/8 patients, 62.5%, p=0.07). Mean MICn was low for Fusarium species (5.7-8 μg/ml) and Acremonium species (5.7-6.8 μg/ml); nevertheless, 46.6% (7/15) patients in the former and 57.1% (4/7) in the latter needed keratoplasty (p=0.61, 0.29, respectively). The mean MICn was low (1.6-4 μg/ml) against dematiaceous fungi.

Conclusions: Most fungal species causing keratitis were sensitive to natamycin except A. flavus. Factors, other than susceptibility to natamycin, play a clinically significant role in the outcome of advanced fungal keratitis.

Disclosure:  N

Acknowledgement: Hyderabad Eye Research Foundation, Hyderabad, India

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