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High-Dose Oral Posaconazole for the Treatment of Recalcitrant Fungal Keratitis
Tanner J Ferguson1, Rachel A Downes1, Carlos M Isada2
1Cole Eye Institute, Cleveland Clinic, Cleveland, OH; and.
Purpose:
To report the successful treatment of 3 cases of recalcitrant fungal keratitis (FK) with high-dose oral posaconazole.
Methods:
This is a series of 3 patients from a single academic center with a culture-positive FK who were treated with oral posaconazole after failing to respond to conventional treatments.
Results:
All 3 patients had a history of contact lens wear. Two of the 3 cases were culture positive for Fusarium and the other for Paecilomyces . The infections of all 3 failed to respond to conventional antifungal therapies including varying combinations of topical, systemic, and intraocular antifungal therapies. All 3 cases rapidly responded to high-dose oral posaconazole ranging from 500 to 600 mg once daily. In 1 case, multiple courses of high-dose therapy were required to treat delayed recurrences of a latent infection. There were no significant adverse effects with the elevated dose, and treatment was administered with the guidance of an infectious disease specialist.
Conclusions:
In cases of recalcitrant FK failing to respond to conventional therapies, high-dose posaconazole, in the delayed-release tablet formulation, can be an effective treatment option.
Insights
High-dose oral posaconazole effectively treated three cases of difficult fungal keratitis (FK) that did not respond to standard therapies. This approach offers a promising option for recalcitrant FK infections.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Fungal keratitis (FK) can be challenging to treat, especially when resistant to conventional therapies.
- Contact lens wear is a significant risk factor for developing FK.
Purpose of the Study:
- To evaluate the efficacy of high-dose oral posaconazole in treating recalcitrant fungal keratitis.
- To report successful outcomes in three patients who failed standard treatments.
Main Methods:
- A case series of three patients with culture-positive FK who received high-dose oral posaconazole.
- Patients had previously failed conventional topical, systemic, and/or intraocular antifungal treatments.
Main Results:
- All three patients showed rapid clinical improvement with oral posaconazole (500-600 mg daily).
- Two cases involved Fusarium, and one involved Paecilomyces; all were resistant to prior treatments.
- One patient required multiple treatment courses for recurrent infection; no significant adverse effects were noted.
Conclusions:
- High-dose oral posaconazole, particularly the delayed-release tablet formulation, is an effective treatment for recalcitrant fungal keratitis.
- This regimen can be a valuable therapeutic option when conventional treatments fail.
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