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Intrastromal Administration of Vancomycin to Maximize Its Early Effect on Methicillin-resistant Staphylococcus Aureus
Ahmet Yucel Ucgul1, Rukiye Kilic Ucgul1, Mustafa Behcet2
1Department of Ophthalmology, Bolu Abant Izzet Baysal University, Training and Research Hospital, Bolu, Turkey.
Purpose:
To evaluate the early efficacy of intrastromal injection of vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA).
Methods:
Twenty-four eyes of 24 New-Zealand White rabbits were included in the study. MRSA keratitis was induced in the right eye of each rabbit. On the 24th hour after the inoculation of MRSA, eight rabbits received topical vancomycin therapy, eight rabbits received intrastromal vancomycin therapy, and eight rabbits received balanced salt solution and served as the control group.
Results:
The pre-post differences in epithelial erosion score and total clinical score were higher in the topical vancomycin group than in the intrastromal vancomycin group (p = .033 and 0.016, respectively). The eyes treated topically had higher bacterial load compared with those treated intrastromally (6.97 ± 0.82 vs. 6.14 ± 0.63 log10 CFU/g, p = .039).
Conclusion:
A single dose of intrastromal vancomycin is more effective than the standard loading dose of topical vancomycin in reducing bacterial load.
Insights
Intrastromal vancomycin injection shows superior early efficacy in treating methicillin-resistant Staphylococcus aureus (MRSA) keratitis. This method significantly reduces bacterial load compared to topical vancomycin therapy.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pharmacology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant threat in infectious keratitis.
- Standard topical vancomycin therapy may have limitations in achieving optimal drug concentrations at the infection site.
Purpose of the Study:
- To evaluate the early therapeutic efficacy of intrastromal vancomycin injection versus topical vancomycin for MRSA keratitis.
Main Methods:
- The study involved 24 New-Zealand White rabbits with induced MRSA keratitis.
- Treatment groups included topical vancomycin, intrastromal vancomycin, and a balanced salt solution control.
- Efficacy was assessed by epithelial erosion score, clinical score, and bacterial load.
Main Results:
- Intrastromal vancomycin demonstrated significantly greater reduction in epithelial erosion and clinical scores compared to topical vancomycin.
- Bacterial load was significantly lower in eyes treated with intrastromal vancomycin than with topical vancomycin (6.14 vs. 6.97 log10 CFU/g).
Conclusions:
- A single intrastromal dose of vancomycin is more effective than standard topical vancomycin loading doses in reducing bacterial load in MRSA keratitis.
- Intrastromal vancomycin offers a promising alternative for managing severe MRSA ocular infections.
