2002 Ocular Microbiology and Immunology Group, Abstract 7

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Fluoroquinolone Therapy of Multiple Drug-Resistant Staphylococcal Keratitis after Lamellar Keratectomy
Peter J. McDonnell, MD¹,²; Tulaya Tungsiripat, MD¹; Melvin A. Sarayba, MD¹; Matthew B. Kaufman, MD¹; Paula M. Sweet, MT¹; Mehran Taban, BS¹; Thomas R. Carpenter, DVM, PhD^3
1Department of Ophthalmology, University of California Irvine, Irvine, CA; ²Doheny
Eye Institute, Keck School of Medicine, University of Southern California, Los
Angeles, CA,³ Department of Safety Evaluation, Allergan, Inc., Irvine, CA

Purpose: To assess the efficacy of gatifloxacin, a fourth generation fluoroquinolone, for treatment of multiple drug-resistant Staphylococcal keratitis after lamellar keratectomy.

Methods: 28 New Zealand white rabbits underwent unilateral lamellar keratectomy followed by inoculation of 1,000 colony-forming units of log-phase multiple drug-resistant Staphylococcus aureus bacteria under each flap. Eyes (7 per group) were randomized then treated immediately and 6,12, and 18 hours after surgery with one drop of the following agents: sterile balanced salt solution, gatifloxacin (0.3%), ciprofloxacin (0.3%) or levofloxacin (0.5%). Two masked observers using a slit lamp graded inflammation 24 and 48 hours after surgery as an indicator of infection severity, and also determined the presence or absence of infectious infiltrates.

Results: No flap complications were encountered during surgery. Infectious infiltrates developed in 5 of 7 eyes per group treated with balanced salt solution, ciprofloxacin, or levofloxacin, whereas no gatifloxacin-treated eyes developed clinical infections. Gatifloxacin-treated eyes exhibited significantly lower mean inflammation scores compared to eyes treated with balanced salt solution, ciprofloxacin, or levofloxacin (P<.011).

Conclusions: The fourth generation fluoroquinolone, gatifloxacin, is a more effective treatment than ciprofloxacin or levofloxacin for multiple drug-resistant Staphylococcal keratitis after lamellar keratectomy, and may be suitable for as prophylaxis for ophthalmic procedures.

Supported by an unrestricted research grant from Allergan Pharmaceuticals, Inc., Irvine, CA.

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