Leap forward in the treatment of Pythium insidiosum keratitis. Issue 12 (15th March 2018)

• Record Type: Journal Article
• Authors: Bagga, Bhupesh; Sharma, Savitri; Madhuri Guda, Sai Jeevan; Nagpal, Ritu; Joseph, Joveeta; Manjulatha, Kodiganti; Mohamed, Ashik; Garg, Prashant
• Is Part Of: British journal of ophthalmology. Volume 102:Issue 12(2018)
• Page Start: 1629
• Page End: 1633
• Publication Date: 2018-03-15
• Subjects: cornea -- infection -- microbiology -- treatment medical -- treatment surgery; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2017-311360
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Background: Pythium insidiosum is a parafungus that causes keratitis resembling fungal keratitis. This study compares outcome in a large cohort of patients with P insidiosum keratitis treated with antifungal drugs, to a pilot group treated with antibacterial antibiotics. Methods: Between January 2014 and December 2016, 114 patients with culture positive P insidiosum keratitis were included in the study. A subset of culture isolates was tested in vitro for response to nine antibacterial antibiotics by disc diffusion and E test. Patients were treated with topical natamycin in 2014, 2015 and up until mid 2016. Thereafter, the patients received a combination of topical linezolid and topical and oral azithromycin. Therapeutic penetrating keratoplasty (TPK) was done for patients not responding to medical therapy. Results: In vitro disc diffusion assay showed linezolid to be most effective. The rate of TPK was significantly higher in 2015 compared with 2016 (43/45, 95.6% vs 22/32, 68.8%; p=0.002). Eighteen patients were treated with antibacterial and 14 were treated with antifungal antibiotic in 2016. One patient was lost to follow-up in each group. The rate of TPK was higher and proportion of healed ulcers was lower (p=0.21, Fisher's exact test) in the group on antifungal therapy (TPK—11/13, 84.6%; Healed—2/13, 15.3%) compared with the group on antibacterial therapy (TPK—11/17, 64.7%; Healed—6/17, 35.2%). Conclusions: We report favourable but not statistically significant response of P insidiosum keratitis to antibacterial agents in a pilot series of patients. Further evaluation of this strategy in larger number of patients is recommended.