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2003 OMIG, Abstract 15

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Comparison of Fungal Contamination In Benzalkonium Chloride (BAK) Preserved and BAK Free Fluoroquinolone Antibiotics
M. Rhee, D. Ritterband, M. Shah, W. Perez, T. Kaiura, R. Koplin, J. Seedor. The New York Eye and Ear Infirmary, New York, New York, and New York Medical College, Valhalla, NY.

Purpose: To compare fungal contamination in benzalkonium chloride (BAK) preserved and BAK free fluoroquinolone antibiotics.
Methods: 5cc aliquots of commercial preparations of fluoroquinolone antibiotics (CILOXANTM, OCUFLOXTM QUIXINTM, VIGAMOXTM and ZYMARTM) were collected in sterile test tubes. Normal saline and thioglycollate broth were used as the negative and positive controls respectively. 1 x 106 CFU/ml Candida albicans ATCC 10231 were inoculated into normal saline and turbidity measured by spectrophotometry. 0.1cc of this suspension was then placed in each of the antibiotics and controls. After vortex mixing, serial dilutions of the specimens were made (1:10 to 1:1000). The tubes were incubated at 30oC. After 3 days, subcultures were performed on Sabouraud dextrose agar (BBL) with a standardized 1uI loop. The plates were incubated at 30oC and subcultures performed on days 1, 7, and 15. United States Pharmacopeia requirements for Antimicrobial Effectiveness Testing were followed.
Results: At days 1, 7, and 15, the colonies in both the normal saline and thioglycollate broth controls were too numerous to count although qualitatively, there were many more colonies in the thioglycollate. At day 7, there was a small increase in the number of CFUs above that anticipated by the serial dilutions in CILOXAN and QUIXIN. Similarly, at day 15, slightly higher growth was noted in CILOXAN and OCUFLOX. No other specimens revealed an increase in the number of CFUs above that anticipated by the serial dilutions; no specimens had fewer CFUs.
Conclusions: No significant difference was found in fungal growth between BAK preserved (CILOXAN , OCUFLOX, QUIXIN, ZYMAR) and BAK free (VIGAMOX) fluoroquinolone antibiotics over the course of the study. These results are reassuring in that there does not appear to be an increased risk of fungal contamination in this particular BAK free antibiotic. BAK free preparations may be beneficial in patients with ocular surface disease or following surgical procedures where BAK might be particularly detrimental. Whether other fluoroquinolone antibiotics would prevent growth of C.albicans in the absence of BAK is unknown.

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