TOPICAL CIPROFLOXACIN FOR TREATING NONTUBERCULOUS MYCOBACTERIAL KERATITIS

Objective: This study aimed to evaluate the clinical efficacy of topic al ciprofloxacin for treating Mycobacterium fortuitum and Mycobacteriu m chelonae keratitis refractory to amikacin therapy. Design: A prospec tive clinical trial of topical ciprofloxacin treatment for nontubercul ous mycobacterial keratitis was conducted. Participants: Eleven patien ts with nontuberculous mycobacterial keratitis diagnosed from 1992 to 1996 were enrolled. Intervention: All 11 patients were treated initial ly with topical fortified amikacin, but only 2 patients responded. The other nine patients, four with M. fortuitum and five with M. chelonae keratitis, were refractory to amikacin therapy and received topical c iprofloxacin treatment. Bacterial culture and drug susceptibility test s using the broth microdilution method were performed on all 11 patien ts. Main Outcome Measures: The clinical response to amikacin or ciprof loxacin treatment was judged by corneal re-epithelialization and densi ty and/or size of corneal infiltrates. Results: M. chelonae isolates w ere more resistant to amikacin and ciprofloxacin than M. fortuitum iso lates based on the in vitro susceptibility test. Clinically, three pat ients with M. fortuitum keratitis were responsive to ciprofloxacin the rapy; however, only one patient with M. chelonae keratitis responded t o the same therapy. Conclusions: Topical ciprofloxacin offers a therap eutic alternative for nontuberculous mycobacterial keratitis, which wa s refractory to amikacin treatment. However, topical ciprofloxacin was more effective for treating M. fortuitum keratitis than for M. chelon ae keratitis.