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Necessity to identify the causative agent for appropriate treatment in fungal corneal ulcer: an in vitro study

M K Gupta1, A Chandra2, P Prakash3

  • 1Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, India.

Journal De Mycologie Medicale
|February 6, 2018
PubMed
Abstract

Insights

Voriconazole demonstrates the lowest minimum inhibitory concentration (MIC) against fungal keratitis pathogens, suggesting its potential as a primary treatment. Higher natamycin MIC against Aspergillus species warrants careful consideration in non-responding cases.

Area of Science:

  • Ophthalmology
  • Mycology
  • Infectious Diseases

Background:

  • Fungal corneal ulcers are a significant cause of preventable blindness globally.
  • Current treatments include natamycin, nystatin, fluconazole, itraconazole, and voriconazole, with natamycin being widely used.
  • Voriconazole is often employed in cases unresponsive to natamycin.

Purpose of the Study:

  • To evaluate the efficacy of various antifungal agents against common fungal keratitis pathogens.
  • To determine the minimum inhibitory concentration (MIC) of fluconazole, itraconazole, voriconazole, nystatin, and natamycin.
  • To inform clinical decisions regarding antifungal drug selection for fungal corneal ulcers.

Main Methods:

  • Minimum inhibitory concentration (MIC) testing was performed.
  • Sixty-one fungal isolates from corneal ulcers were tested.
  • Testing followed the Clinical and Laboratory Standards Institute (CLSI) guidelines.

Main Results:

  • Antifungal agent MIC values varied significantly among different fungal strains.
  • Voriconazole exhibited the lowest MIC values compared to fluconazole and itraconazole.
  • Aspergillus species demonstrated higher natamycin MIC values.
  • Fusarium species showed poor susceptibility to itraconazole.

Conclusions:

  • Accurate identification of the causative fungus is crucial for effective antifungal therapy.
  • The low voriconazole MIC supports its consideration as a first-line treatment.
  • Clinicians should consider MIC testing for non-responding fungal corneal ulcers, especially when Aspergillus is suspected due to potentially higher natamycin MICs.
Keywords:
Corneal ulcerFluconazoleMICNatamycinNystatinVoriconazole

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