Contact lens-related keratitis: Is topical fluoroquinolone therapy adequate?

K. S. Bower, R. P. Kowalski, D. K. Dhaliwal, Y. J. Gordon

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose. Corneal infiltrates in contact lens (CL) wearers can be infectious or sterile. A recent trend in CL-related keratitis therapy is to treat topically with a fluoroquinolone. To evalutate fluoroquinolone therapy, we studied the microbial flora and antibiotic susceptibility of lens case contaminants in patients with CL-related keratitis. Methods. We reviewed the clinical and laboratory records of 46 patients with CL-related keratitis for clinical findings, and corneal and lens case culture results. The susceptibility patterns of bacterial isolates were examined for ciprofloxacin (CIP), ofloxacin (OFX), and the combination of cefazolin and tobramycin (TOB/CEF). Results. Our review found that 14/46 patients (30%) had positive corneal cultures and clinical findings consistent with infectious keratitis. In this group, the same bacteria also grew from 11/14 CL cases (73%). Susceptibility patterns of the 14 bacterial pathogens (64% gram-negative) to CIP (93%), OFX (100%), and TOB/CEF (100%) did not differ significantly (p=0.5). The remaining 32/46 patients (70%) had negative corneal cultures and clinical findings most consistent with sterile, or immune, infiltrates. In this group, all of the CL cases were contaminated, usually heavily, and often a polymicrobial "soup". The 54 lens case isolates (98% gram-negative) demonstrated susceptibility to CIP (94%), OFX (87%), and TOB/CEF (59%). CIP and OFX did not differ (p=0.3), but both were significantly better than TOB/CEF (p=0.002). Conclusions. This in vitro study indicates that topical therapy with a fluoroquinolone, along with appropriate laboratory studies and discontinuation of CL wear, is a rational approach in the initial management of CL-related keratitis.

Original languageEnglish (US)
Pages (from-to)S876
JournalInvestigative Ophthalmology and Visual Science
Volume37
Issue number3
StatePublished - Feb 15 1996
Externally publishedYes

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

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