netilmicin and Keratitis

To report clinical manifestations of a female patient with bilateral bacterial keratitis following photorefractive keratectomy (PRK). Bilateral PRK was performed for moderate hyperopia. Bandage contact lenses were fitted at the conclusion of the surgery. Bilateral infectious keratitis with hypopion was diagnosed within 4 days after surgery. Smear and culture were obtained and showed the presence of methicillin-resistant Staphylococcus aureus (MRSA). The patient was treated with systemic prednisone and topical antibiotics (vancomycin, tobramycin and netylmicin) and betamethasone. After 1 month corneal leukoma was still present and remained unchanged during the following 7 months. Infectious keratitis is a rare complication of PRK that appears early in the postoperative period. MRSA keratitis may determine long-term visual impairment despite prompt therapeutic intervention.

Topics: Anti-Infective Agents; Antitubercular Agents; Aza Compounds; Diagnosis, Differential; Dose-Response Relationship, Drug; Female; Fluoroquinolones; Follow-Up Studies; Humans; Hyperopia; Keratitis; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Moxifloxacin; Netilmicin; Ophthalmic Solutions; Photorefractive Keratectomy; Quinolines; Staphylococcal Infections; Visual Acuity

Peak and trough tear and serum concentrations were determined in 27 human volunteers undergoing intravenous (IV) gentamicin sulfate, tobramycin sulfate, amikacin sulfate, and netilmicin sulfate therapy. Although effective serum concentrations were achieved, tear levels were subtherapeutic. The mean peak tear concentrations were 0.4 microgram/mL, 0.5 microgram/mL, 1.7 micrograms/mL, and 0.3 microgram/mL for gentamicin, tobramycin, amikacin, and netilmicin, respectively. These levels did not approach the minimum inhibitory concentrations for Pseudomonas and raise some concern regarding the risk-benefit ratio of IV antibiotics for bacterial keratitis.

Topics: Adult; Aged; Amikacin; Bacterial Infections; Female; Gentamicins; Humans; Infusions, Parenteral; Kanamycin; Keratitis; Male; Microbial Sensitivity Tests; Middle Aged; Netilmicin; Tears; Tobramycin