Evaluation of Intracameral Amphotericin B in the Management of Fungal Keratitis: Randomized Controlled Trial
Namrata SharmaPreeti SankaranTushar AgarwalTarun AroraBhavna ChawlaJeewan S. TitiyalRadhika TandonGita SatapathyRasik B. Vajpayee
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Abstract:
Purpose: To evaluate the efficacy and safety of intracameral amphotericin B (ICAMB) in the management of fungal keratitis.Methods: In total, 45 eyes with smear-confirmed fungal keratitis with hypopyon were randomized into three treatment groups: Group I (topical antifungal treatment + oral antifungal); Group II (topical antifungal treatment + ICAMB + oral antifungal); and Group III (topical antifungal treatment + drainage of hypopyon + ICAMB + oral antifungal). The main outcome measures were treatment success rate, time to heal, visual acuity gain, and presence of complications.Results: There were no differences in the treatment success rates (p = 0.66), time to healing (p = 0.18), or mean final visual acuity (logMAR) (p = 0.8) between the three groups. The major complication observed was increased incidence of cataract in group III (40%), though it was statistically insignificant.Conclusions: ICAMB does not offer any benefit over topical antifungal therapy when performed alone or associated with drainage of hypopyon.Keywords:
Fungal Keratitis
Hypopyon
Objective To study the clinical effect of fluconazole combined with amphotericin B for treatment of fungal corneal ulcer.Methods The clinical data of 48 cases(eyes)with fungal corneal ulcer who were treated with fluconazole and amphotericin B were analyzed.Results Among 48 cases(eyes),40 cases(eyes)were healed completely,5 cases(eyes)recoveryed partly and 3 cases(eyes)was not controlled,the recoveryed rate was 83.3% and the total effective rate was 93.75%.Conclusion The combination use of fluconazole and amphotericin B has certain effect for fungal corneal ulcer,which is worth popularizing.
corneal ulcer
Fungal Keratitis
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Background: A multicentre study was carried out in Ghana and southern India to determine the aetiology of suppurative keratitis in two regions located at similar tropical latitudes. Studies of fungal keratitis from the literature were reviewed. Methods: Patients presenting at rural and urban eye units with suspected microbial keratitis were recruited to the study. Corneal ulceration was defined as loss of corneal epithelium with clinical evidence of infection with or without hypopyon. Microscopy and culture were performed on all corneal specimens obtained. Results: 1090 patients were recruited with suspected microbial keratitis between June 1999 and May 2001. Overall the principal causative micro-organisms in both regions were filamentous fungi (42%): Fusarium species and Aspergillus species were the commonest fungal isolates. Pseudomonas species were most frequently isolated from cases of bacterial keratitis in Ghana but in India the commonest bacterial isolates were streptococci. Conclusion: Infections of the cornea due to filamentous fungi are a frequent cause of corneal damage in developing countries in the tropics and are difficult to treat. Microscopy is an essential tool in the diagnosis of these infections. A knowledge of the "local" aetiology within a region is of value in the management of suppurative keratitis in the event that microscopy cannot be performed.
Fungal Keratitis
Hypopyon
Etiology
corneal ulcer
Corneal ulceration
Corneal Diseases
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The activity of fluconazole and amphotericin B against three isolates of Cryptococcus neoformans was evaluated, with fluconazole and amphotericin B MICs of 2.0-4.0 mg/L and 1.0 mg/L respectively, using time-kill curve methods. Fluconazole was fungistatic against all isolates tested (<99.9% decrease in cfu from initial inoculum). The fungistatic activity of fluconazole was not enhanced by increasing the concentration of antifungal in solution. In contrast, amphotericin B was markedly fungicidal (> or = 99.9% decrease in cfu from initial inoculum). Both the rate and the extent of amphotericin B activity were enhanced when drug concentration was increased.
Pharmacodynamics
Antifungal drugs
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Objective To observe the efficacy of fluconazole combined iodine treated with fungal keratitis.MethodsAccording to treatment order,68 cases fungal keratitis paitents were divided into observation group and control group,each of 34 cases.Observation group were treated with fluconazole combined iodine,the control group received amphotericin B.After treatment,effects of two groups were observed.Results The effect of fluconazole combined iodine treated with fungal keratitis was better than amphotericin B,the difference was statistically significant(P0.05).Conclusion The effect of fluconazole combined iodine treated with fungal keratitis is significant,adverse reactions is small.
Fungal Keratitis
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Cryptococcus gattii is the main pathogen of cryptococcosis in healthy patients and is treated mainly with fluconazole and amphotericin B. The combination of these drugs has been questioned because the mechanisms of action could lead to a theoretical antagonistic interaction. We evaluated distinct parameters involved in the in vitro combination of fluconazole and amphotericin B against Cryptococcus gattii. Fourteen strains of C. gattii were used for the determination of MIC, fractional inhibitory concentration, time-kill curve, and postantifungal effect (PAFE). Ergosterol quantification was performed to evaluate the influence of ergosterol content on the interaction between these antifungals. Interaction between the drugs varied from synergistic to antagonistic depending on the strain and concentration tested. Increasing fluconazole levels were correlated with an antagonistic interaction. A total of 48 h was necessary for reducing the fungal viability in the presence of fluconazole, while 12 h were required for amphotericin B. When these antifungals were tested in combination, fluconazole impaired the amphotericin B activity. The ergosterol content decreased with the increase of fluconazole levels and it was correlated with the lower activity of amphotericin B. The PAFE found varied from 1 to 4 h for fluconazole and from 1 to 3 h for amphotericin B. The interaction of fluconazole and amphotericin B was concentration-dependent and special attention should be directed when these drugs are used in combination against C. gattii.
Cryptococcus gattii
Ergosterol
Azole
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Several studies have reported the occurrence of infections caused by Candida yeasts as well as the increasing prevalence of non albicans species. The aim of the present work is focused on the obtaining of heteroresistance to amphotericin B and fluconazole in Candida species using two distinct methodologies: selection and induction. Resistant samples were obtained by selective pressure using a medium with fluconazole for growth, followed by growth in a medium with amphotericin B. The selective pressure was also created beginning with growth in amphotericin B medium followed by growth in fluconazole medium. Concomitantly, samples were submitted to the induction of resistance through cultivation in increasing concentrations of fluconazole, followed by cultivation in increasing concentrations of amphotericin B. Subsequently, the induction began with amphotericin B followed by fluconazole. Three samples resistant to fluconazole and amphotericin B were obtained, two by induction (C. glabrata and C. tropicalis) and one by selection (C. tropicalis). Both C. tropicalis originated from the same wild sample. After successive transfers for drug free medium, only the sample obtained by selection was able to maintain the resistance phenotype. These results suggest that the phenotype of heteroresitance to fluconazole and amphotericin B can be produced by two methodologies: selection and induction.
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To review the clinical features and therapeutic effects of fungal keratitis (FK).110 cases (110 eyes) with the disease were divided into two types: hyphomycetic keratitis in 94 eyes and candida keratitis in 16 eyes. The clinical features and therapeutic effects of the two types were observed and compared.The hyphomycetic keratitis generally had a plant traumatic history. The border of corneal infiltration was not clear with feather edges, and had a tendency to penetrate into the deep stroma of cornea. There were endothelial plaques, hypopyon and bad therapeutic effects. The pathogenicity of cardida keratitis (CK) was related to the local long-term use of glucocorticoid, the fungus seldom expanded into the deep corneal layers and infiltrated into the inner eye. Its therapeutic effects were better. The border of CK was characterized with limitations, and was clear.The clinical features of the two types are different. The clinical features caused by different or the same pathogenic fungi show great variations. Early diagnoses, correct use of medicine and operation are the key points to increase the curative rate.
Hypopyon
Fungal Keratitis
Therapeutic effect
Corneal Diseases
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The activities of fluconazole and amphotericin B against Histoplasma capsulatum were investigated. The minimum inhibitory concentrations ranged from 0.12 to 0.47 µg/mL for amphotericin B and from 16 to 250 µg/mL for fluconazole. Fluconazole given orally twice a day for 6 consecutive days compared favorably with amphotericin B given intraperitoneally once every other day for a total of six doses in the treatment of histoplasmosis in normal and leukopenic mice.
Histoplasma
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