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Recurrence of microbial keratitis concomitant with antiinflammatory treatment in an animal model
D C Gritz1, S Kwitko, M D Trousdale
1Doheny Eye Institute, Los Angeles, CA 90033.
Abstract:
Recurrence of Pseudomonas keratitis during treatment with corticosteroids has been reported previously in humans. Rabbits with keratitis due to Pseudomonas aeruginosa or Streptococcus pneumoniae were treated with antibiotics and either vehicle, methylprednisolone acetate, flurbiprofen, or nordihydroguaiaretic acid (NDGA). Cultures performed after 7 days were negative, and antibiotics were discontinued. Two weeks later, Pseudomonas keratitis recurred in 6 of 7 (85.7%) steroid-treated rabbits, 1 of 8 (12.5%) flurbiprofen-treated rabbits, 1 of 8 (12.5%) NDGA-treated rabbits, and none of 8 vehicle-treated rabbits. None of the 31 rabbits infected with Streptococcus pneumoniae experienced recurrence. These data confirm the clinical observation that Pseudomonas keratitis may recur if antibiotic therapy is discontinued and corticosteroids are administered; the risk of recurrence appears to be much less with nonsteroidal antiinflammatory agents.
Insights
Corticosteroid treatment for Pseudomonas keratitis in rabbits led to high recurrence rates after antibiotics were stopped. Nonsteroidal anti-inflammatory drugs significantly reduced this risk, unlike steroids.
Area of Science:
- Ophthalmology
- Microbiology
- Pharmacology
Background:
- Pseudomonas keratitis recurrence during corticosteroid therapy is a known clinical issue.
- Corticosteroids can suppress immune responses, potentially exacerbating bacterial infections.
- Understanding factors influencing recurrence is crucial for effective treatment strategies.
Purpose of the Study:
- To investigate the recurrence rates of Pseudomonas keratitis in a rabbit model.
- To compare the effect of corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and vehicle on recurrence.
- To evaluate the role of specific anti-inflammatory agents in preventing Pseudomonas keratitis relapse.
Main Methods:
- Rabbits with Pseudomonas aeruginosa or Streptococcus pneumoniae keratitis were treated with antibiotics.
- Concurrent treatment included methylprednisolone acetate, flurbiprofen, nordihydroguaiaretic acid (NDGA), or vehicle.
- Antibiotics were discontinued after negative cultures, and recurrence was monitored for two weeks.
Main Results:
- Pseudomonas keratitis recurred in 85.7% of steroid-treated rabbits versus 12.5% for flurbiprofen and NDGA groups.
- No recurrence was observed in vehicle-treated rabbits or in rabbits infected with Streptococcus pneumoniae.
- NSAIDs (flurbiprofen, NDGA) demonstrated a significant protective effect against Pseudomonas keratitis recurrence.
Conclusions:
- Corticosteroid administration is associated with a high risk of Pseudomonas keratitis recurrence after antibiotic cessation.
- Nonsteroidal anti-inflammatory agents appear to mitigate the risk of recurrence, offering a potentially safer alternative.
- These findings support clinical observations and highlight the importance of anti-inflammatory agent choice in managing bacterial keratitis.