USE OF ROUTINE ANTIBIOTIC-SENSITIVITY TESTING FOR THE MANAGEMENT OF CORNEAL ULCERS

Objective: To prospectively evaluate the clinical importance of antibi otic sensitivities for the management of corneal ulcers. Methods: Thir ty-two consecutive patients referred to the Cornea Service at Wills Ey e Hospital, Philadelphia, Pa, between October 1, 1993, and May 31, 199 4, with a culture-positive corneal ulcer were studied prospectively. B road-spectrum empirical antibiotic therapy with intensive topical fort ified antibiotics was initiated after smear and culture results were o btained. The therapy was modified based on clinical appearance, stain results, or organism identification. Clinicians were masked to the sen sitivity results. Results: Fifteen patients healed after receiving the initial empirical antibiotic therapy (group 1). The antibiotic regime ns of 6 patients were modified after the stain and/or culture results were available, although the clinical appearance suggested continued i mprovement while taking the initial regimen (group 2). Eleven patients had ulcers that either failed to improve or worsened after receiving the initial empirical therapy (group 3). Seven of these patients ultim ately improved with a change in therapy; treatment failed in 4 patient s. Nine patients (5 for whom antibiotic therapy succeeded and 4 for wh om it failed) should have been adequately treated by the initial antib iotic therapy, according to sensitivity results. In the remaining 2 pa tients, in vitro sensitivity testing did not include the antibiotics u sed for the initial treatment. In all cases, the organisms were sensit ive to the empirically altered regimen of antibiotics. Conclusions: Th ese preliminary results suggest that routine antibiotic susceptibility tests do not provide clinically useful information for the management of corneal ulcers. The identification of the organisms based on the r esults of smears and cultures was sufficient for the selection and mod ification of topical antibiotic therapy.