zithromax and Keratitis

The aim of this study was to compare the efficacy of monotherapy (topical linezolid 0.2%) versus a combination of antibiotics (topical linezolid 0.2% and topical azithromycin 1%) for the treatment of Pythium insidiosum keratitis.. Cases of P. insidiosum keratitis were prospectively randomized into group A on topical 0.2% linezolid along with topical placebo (sodium carboxymethyl cellulose [CMC] 0.5%) and group B on a combination of topical 0.2% linezolid and topical 1% azithromycin. Both groups were compared by proportion of both clinical resolution and worsening of keratitis along with the number of therapeutic penetrating keratoplasty (TPK) performed at 3 months.. We initially planned N = 66 patients but later limited to 20 (N = 10 in each group) patients owing to one interim analysis. The average size of the infiltrate in group A and B was 5.6 ± 1.5 mm and 4.8 ± 2.0 mm, respectively, with a mean Logarithm of the Minimum Angle of Resolution (logMAR) visual acuity of 2.74 ± 0.55 and 1.79 ± 1.19. At 3 months, from group A, 7 (70%) patients needed TPK and 2 patients had signs of resolution, whereas from group B, 6 (60%) patients achieved complete resolution ( P = 0.0003) and 2 were improving while only 1 needed TPK ( P = 0.02). The median duration of treatment in group A and B, with the study drugs, was 31 days (17.8-47.8) and 101.5 days (80-123.3), P value = 0.003, respectively. Final visual acuity at 3 months was 2.50 ± 0.81 and 0.75 ± 0.87, P = 0.02, respectively.. A combination of topical linezolid and topical azithromycin was found to have superior efficacy than the monotherapy with topical linezolid for the management of Pythium keratitis.

Topics: Anti-Bacterial Agents; Antifungal Agents; Azithromycin; Humans; Keratitis; Linezolid; Pythium

After keratoplasty, antibiotic eye drops are used to prevent ocular infection until the recipient corneal epithelium has healed. We compared the effects of azithromycin, a new macrolide, with the effect of the standard antibiotics, tobramycin, on the (i) prevention of infection, (ii) epithelial healing, and (iii) ocular tolerance after penetrating keratoplasty.. In this prospective, single-center, randomized study, patients undergoing penetrating keratoplasty received postoperative topical dexamethasone and either azithromycin (n=23; Azyter(®); one drop twice daily for 3 days) or tobramycin (n=23; Tobrex(®); 1 drop 4 times daily until complete re-epithelialization). Daily slit-lamp examination with fluorescein was performed, and photographs were taken to digitally assess the re-epithelialized surface area. Daily questionnaires assessed ocular comfort and pain.. There were no cases of infection in either group. The re-epithelialized area of the corneal graft increased at a similar rate in each group, with no difference between the groups on any day. The mean±SD days until complete re-epithelialization did not differ between tobramycin (4.14±1.17) and azithromycin (4.13±1.82) (P=0.89). Superficial punctate keratitis scores were similar for tobramycin (1.39) and azithromycin (1.34). Pain and discomfort scores improved each day after surgery with no differences between the groups on any day.. Postkeratoplasty epithelial healing and ocular tolerance were not significantly different between the azithromycin- and tobramycin-treatment groups. Our results support the use of azithromycin as an alternative to tobramycin after corneal surgery such as keratoplasty.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Inflammatory Agents; Azithromycin; Cornea; Corneal Diseases; Dexamethasone; Epithelium, Corneal; Female; Humans; Keratitis; Keratoplasty, Penetrating; Male; Middle Aged; Ophthalmic Solutions; Pain, Postoperative; Postoperative Period; Prospective Studies; Surgical Wound Infection; Tobramycin; Wound Healing; Young Adult

To evaluate the efficacy of azithromycin hydrate ophthalmic solution for the treatment of internal hordeolum and meibomitis with or without phlyctenular keratitis.. Retrospective study.. Patients diagnosed with internal hordeolum or meibomitis were prescribed azithromycin hydrate ophthalmic solution twice daily for 2 days and then once daily for 12 days. Depending on the presence of meibomitis-related keratoconjunctivitis (MRKC), we further divided the patients with meibomitis into three subgroups: meibomitis alone (non-MRKC group), meibomitis with non-phlyctenular MRKC (non-phlyctenular group), and meibomitis with phlyctenular MRKC (phlyctenular group). Inflammatory findings (eyelid redness and conjunctival hyperemia) were scored before and after treatment. Some patients also underwent culture testing fluids discharged by the meibomian gland orifices.. Three patients (3 eyes) had internal hordeolum and 16 patients (16 eyes) had meibomitis. After treatment, the inflammatory findings disappeared in all eyes with internal hordeolum. Among the patients with meibomitis, three eyes were in the non-MRKC, six in the non-phlyctenular, and seven in the phlyctenular group. The inflammatory findings were significantly improved only in the phlyctenular group. Among seven eyes with positive culture results, Cutibacterium acnes was detected in five, and treatment improved the inflammatory findings in all of these eyes.. Azithromycin hydrate ophthalmic solution is effective for the treatment of inflammatory meibomian gland diseases, including internal hordeolum and meibomitis. In particular, the agent is highly efficient in patients with phlyctenular MRKC.

Topics: Anti-Bacterial Agents; Azithromycin; Blepharitis; Hordeolum; Humans; Inflammation; Keratitis; Keratoconjunctivitis; Meibomian Glands; Meibomitis; Ophthalmic Solutions; Retrospective Studies

The purpose of this study was to present the successful management and outcomes in a series of 6 cases of culture-positive nontuberculous mycobacterial keratitis after clear corneal incision phacoemulsification surgery.. This is a case series of 6 consecutive eyes that presented at the Cornea Division at an academic institution, diagnosed with culture-positive nontuberculous mycobacterial keratitis after phacoemulsification surgery.. Six eyes of 5 patients were included. The mean interval from cataract surgery to presentation was 7.7 weeks. All cases presented with intrastromal abscesses adjacent to corneal incisions, and 2 had scleral extension of the infection. Isolated organisms were Mycobacterium abscessus (n = 4), Mycobacterium chelonae (n = 1), and Mycobacterium mucogenicum (n = 1). All cases were treated with topical amikacin 8 mg/mL for 10.5 weeks on average. All cases received either oral clarithromycin at 500 mg twice-daily dosage or oral azithromycin at 500 mg daily. Two patients with scleral abscesses underwent surgical debridement with amniotic membrane grafts. All 6 eyes achieved infection resolution and good visual recovery, with the final visual acuity ranging from 20/20 to 20/60. None of the patients experienced recurrence of infection.. Prompt medical treatment with combined topical and oral therapy can lead to infection resolution and favorable visual recovery. Early surgical intervention can ensure good outcomes in cases of scleral extension.

Topics: Abscess; Amikacin; Azithromycin; Clarithromycin; Eye Infections, Bacterial; Florida; Humans; Keratitis; Mycobacterium Infections, Nontuberculous; Phacoemulsification

Pythium insidiosum causes a rare sight-threatening keratitis and is a devastating ocular pathology with a high morbidity. It is frequently mistaken as fungal keratitis. Here we highlight a rare case of pediatric Pythium insidiosum keratitis which was successfully managed using an antibiotic combination of linezolid and azithromycin with cyanoacrylate glue.. A 9-year-old young male child presented to our clinic with defective vision, pain, redness in the right eye for 5 days post stick injury. In the right eye, Snellen's best-corrected visual acuity (BCVA) was 6/12 which deteriorated to hand movements within 5 days of treatment. Ocular examination revealed 6 × 5 mm dry-looking mid stromal corneal infiltrate with feathery margin involving the visual axis. The clinical picture was suggestive of fungal keratitis. Corneal scraping and smear examination with 10% KOH and Gram stain revealed long slender hyaline hyphae with sparse septations. Before the culture result, the patient was started on 5% Natamycin and 1% Itraconazole hourly, but still, the infiltrate progressed. Further, P. Insidiosum keratitis was considered as the differential, which was confirmed on blood agar culture. After receiving culture results, the patient was managed with 0.2% Linezolid and 1% Azithromycin hourly. Due to the rapid progression of infiltrate, corneal melt, and younger age, cyanoacrylate glue, and bandage contact lens were used. On the last follow-up, the BCVA recovered to 6/12.. Prompt diagnosis, clinical awareness, and a specific treatment regime is needed for managing this devastating corneal entity. Cyanoacrylate glue due to its antibacterial properties can be a potential rescuer and can be considered for managing these cases.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Child; Corneal Ulcer; Cyanoacrylates; Eye Infections, Fungal; Humans; Keratitis; Linezolid; Male; Pythiosis; Pythium

To describe the clinical features, microbiological profile, and outcome of a series of cases of Pythium keratitis treated with topical and oral linezolid and topical azithromycin eye drops.. This was a retrospective interventional case series of microbiologically and/or histopathologically proven cases of Pythium keratitis seen between October 2016 and December 2019. All patients received a combination of topical linezolid and/or azithromycin eye drops with oral linezolid. Analysis of demographic data, predisposing risk factors, microbiological results, treatment regimen, visual acuity, surgical intervention, and final outcome was performed. A subgroup analysis of cases >6 mm in size was performed. Success was defined as complete resolution on medical management. Failure was defined as worsening of infection necessitating therapeutic penetrating keratoplasty or evisceration.. Of 21 cases, 2 were lost to follow up, 1 was diagnosed on histopathology, and 1 received only topical linezolid. Characteristic microbiological features were noted on 10% potassium hydroxide calcofluor white wet mount in 20/21 (95.23%) and Gram stain in 18/21 (85.71%). On triple drug regimen, 14/17 cases (82.35%) resolved. Average time to resolution was 87.64 ± 44.44 days. More than 60% infiltrates (13/21) were large, and 66.66% infiltrates resolved in 109.3 ± 57.06 days. Of the 5 failures, 4 needed therapeutic keratoplasty and 1 needed evisceration. All grafts failed.. The dual topical drug regimen with oral linezolid has good cure rates (over 80%) for Pythium keratitis over prolonged duration. It is recommended to persevere with medical therapy even in large infiltrates because more than two thirds resolved.

Topics: Administration, Ophthalmic; Administration, Oral; Adolescent; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Child; Drug Therapy, Combination; Eye Infections, Parasitic; Female; Humans; Keratitis; Linezolid; Male; Middle Aged; Ophthalmic Solutions; Pythiosis; Retrospective Studies; Treatment Outcome

We aimed to demonstrate the contribution of anti-inflammatory and anti-virulence effects of azithromycin (AZM) in ocular surface infection treatment.. Staphylococcus aureus was injected into the corneal stroma of rabbits to induce keratitis. AZM at concentrations of 0.01, 0.1, and 1% was instilled into the eye twice daily. The eyes were examined using a slit lamp and scored. The viable bacteria in the cornea were counted at 48 h post infection. To evaluate the anti-inflammatory efficacy of AZM, S. aureus culture supernatant-induced anterior ocular inflammation in rabbit was examined using a slit lamp and scored. To evaluate the inhibitory effect of AZM on bacterial toxin production, S. aureus was cultured with AZM and hemolytic reaction in the culture supernatant was determined.. In the bacterial keratitis model, AZM dose-dependently inhibited the increase in the clinical score. The viable bacterial count in the cornea treated with 1% AZM significantly decreased compared with that of the vehicle, whereas bacterial count in 0.01 and 0.1% AZM-treated corneas was similar to that of the vehicle. In the anterior ocular inflammation model, 0.1 and 1% AZM inhibited the increase in the clinical score. AZM inhibited hemolytic reaction at concentrations that did not inhibit bacterial growth.. The results demonstrated that AZM has not only anti-bacterial, but also anti-inflammatory effects, and inhibits bacterial toxin production leading to ocular surface damage in bacterial infection. Thus, the therapeutic effect of AZM against ocular infections is expected to be higher than that which could be assumed if it only had anti-bacterial activity.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Colony Count, Microbial; Cornea; Disease Models, Animal; Eye Infections, Bacterial; Keratitis; Male; Rabbits; Staphylococcal Infections; Staphylococcus aureus; Virulence

Rosacea fulminans (RF) is a severe form of facial dermatosis presenting with a sudden onset of numerous facial pustules, papules, and erythema. During pregnancy its treatment may be difficult and can have an impact on obstetrical outcomes.. A 37-year-old woman during the 37th week of her fourth pregnancy presented RF that was associated with ocular manifestations. The usual treatment with isotretinoin was contraindicated during pregnancy and the patient started an alternative treatment with prednisone and azithromycin. After delivery at 38 weeks of gestational age, there was a significant improvement.. RE is a severe dermatological disease with unknown etiology and with a rapid improvement in the immediate postpartum period.

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Azithromycin; Conjunctivitis; Facial Dermatoses; Female; Humans; Keratitis; Prednisone; Pregnancy; Pregnancy Complications; Rosacea

Amoebic keratitis is a potentially blinding eye infection caused by ubiquitous, free-living, environmental acanthamoebae, which are known to harbor bacterial endosymbionts. A Chlamydia-like endosymbiont has previously enhanced Acanthamoeba virulence in vitro. We investigated the potential effect of Acanthamoeba-endosymbiont coinfection in a human corneal tissue model representing clinical amoebic keratitis infection.. Environmental and corneal Acanthamoeba isolates from the American Type Culture Collection were screened for endosymbionts by amplifying and sequencing bacterial 16S as well as Chlamydiales-specific DNA. Each Acanthamoeba isolate was used to infect EpiCorneal cells, a 3-dimensional human corneal tissue model. EpiCorneal cells were then treated with azithromycin, doxycycline, or control medium to determine whether antibiotics targeting common classes of bacterial endosymbionts attenuated Acanthamoeba virulence, as indicated by decreased observed cytopathic effect and inflammatory biomarker production.. A novel endosymbiont closely related to Mycobacterium spp. was identified in Acanthamoeba polyphaga 50495. Infection of EpiCorneal cells with Acanthamoeba castellanii 50493 and A. polyphaga 50372 led to increased production of inflammatory cytokines and cytopathic effects visible under microscopy. These increases were attenuated by azithromycin and doxycycline.. Our findings suggest that azithromycin and doxycycline may be effective adjuvants to standard antiacanthamoebal chemotherapy by potentially abrogating virulence-enhancing properties of bacterial endosymbionts.

Topics: Acanthamoeba; Amebiasis; Azithromycin; Biomarkers; Cells, Cultured; Chlamydiaceae; Cornea; Cytokines; Doxycycline; Humans; Keratitis; RNA, Ribosomal, 16S; Symbiosis; Virulence

To describe the previously unreported successful treatment of presumptive Pythium keratitis (PK) with medical therapy alone.. A 42-year-old female homemaker presented to us with a 15-day history of pain and redness in the right eye after a trivial injury. Her vision was 20/80 at presentation. Slit-lamp biomicroscopy revealed a central, dense and dry-looking, grayish-white infiltrate reaching mid stroma. The infiltrate had feathery margins and was surrounded by multiple tentacle-like lesions and peripherally expanding pinhead-sized subepithelial lesions. The contralateral eye was essentially normal. Diagnostic corneal scraping on smears revealed broad, aseptate, hyaline filaments with ribbon-like folds; very characteristic of Pythium species. Confocal imaging revealed fungal filaments. Based on corroborative evidence, a diagnosis of presumptive PK was made. She was administered a combination therapy consisting of eye drop linezolid 0.2% 1 hourly, azithromycin 1% 2 hourly, atropine sulfate 1% thrice daily, and oral azithromycin 500 mg once daily for 3 days in a week.. After initial worsening in the form of stromal expansion, regression of pinhead-sized lesions was seen with onset of scarring by as early as day 4 of intense medical therapy. The tentacle-like lesions did not worsen. On day 8, significant resolution was noted with scarring, and by the end of 2 weeks, the entire stromal lesion had scarred and complete resolution of expanding tentacles was observed in 3 weeks.. Presumptive Pythium keratitis of the patient completely resolved with antibacterial treatment alone. It is pertinent for ophthalmologists to be aware of this new treatment regimen.

Topics: Administration, Oral; Administration, Topical; Adult; Anti-Bacterial Agents; Atropine; Azithromycin; Drug Therapy, Combination; Eye Infections, Parasitic; Female; Humans; Keratitis; Linezolid; Mydriatics; Ophthalmic Solutions; Pythiosis; Pythium

To determine whether the addition of a bioadhesive drug-delivery system to topical azithromycin induces intraocular inflammation and damage when introduced intraocularly by different approaches and in varying doses.. John A. Moran Eye Center, Salt Lake City, Utah, USA.. Experimental study.. Commercial topical azithromycin 1.0% was duplicated, including the benzalkonium chloride, but without inclusion of the Durasite bioadhesive drug-delivery system. Injections of 50 μL, 25 μL, and 10 μL of the antibiotic solutions were administered in a masked fashion to 2 rabbits; 1 eye (study eye) in each rabbit was randomized to receive azithromycin with the delivery system and the fellow eye (control eye) to receive azithromycin without the delivery system. Two rabbits had topical drops of each solution placed after a 2.8 mm incision was created. Masked slitlamp examinations, pachymetry, and intraocular pressure (IOP) were determined 1 day and 2 days postoperatively. The animals were humanely killed, and the endothelial density and histopathology were examined.. The IOP (P<.001), pachymetry (P<.001), and signs of inflammation (P=.38 to .003) were consistently higher in the study eye, especially at the 50 μL dose, than in the control eye. This was confirmed by histopathology.. If the drug-delivery system gains access to the anterior chamber, it may cause substantial corneal edema and inflammation, even at low doses and after topical administration.

Topics: Administration, Topical; Animals; Anterior Chamber; Anti-Bacterial Agents; Azithromycin; Cell Count; Corneal Edema; Corneal Endothelial Cell Loss; Drug Delivery Systems; Endothelium, Corneal; Intraocular Pressure; Keratitis; Male; Ophthalmic Solutions; Rabbits

To determine the effect of azithromycin (AZM) in a murine model of corneal inflammation.. The effect of topical AZM was studied in murine corneal inflammation. Corneal inflammation was induced by thermal cautery in BALB/c mice. Leukocyte infiltration at different time points was analyzed by flow cytometry. At set time points, real-time polymerase chain reaction was performed to quantify the expression of different inflammatory cytokine transcript in the cornea. Corneal samples were analyzed immunohistochemically for the expression of intercellular adhesion molecule-1 (ICAM-1). Corneal neovascularization (CNV) was induced by micropellet (VEGF-A) placement. Mice were then treated topically with either AZM or vehicle. CNV was evaluated morphometrically.. Eyes receiving AZM showed a significant decrease in corneal infiltration compared with the vehicle-treated group. AZM also significantly decreased messenger RNA expression levels of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and ICAM-1 in the cornea. There was no significant difference in CNV between the AZM- and vehicle-treated groups.. After an inflammatory insult, topical AZM significantly reduced leukocyte infiltration into the cornea. This was further supported by an associated decrease in expression of IL-1β, TNF-α, and ICAM-1 in the cornea, indicating AZM may have a potential anti-inflammatory effect on corneal inflammation.

Topics: Administration, Topical; Animals; Anti-Bacterial Agents; Azithromycin; Cell Movement; Cornea; Corneal Neovascularization; Disease Models, Animal; Flow Cytometry; Fluorescent Antibody Technique, Indirect; Gene Expression; Immunity, Innate; Intercellular Adhesion Molecule-1; Interleukin-1beta; Keratitis; Leukocytes; Male; Mice; Mice, Inbred BALB C; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Tumor Necrosis Factor-alpha

To describe the time course, diagnosis, clinical features, and treatment of seven patients with Mycobacterium szulgai keratitis that developed from 7 to 24 weeks after laser in situ keratomileusis (LASIK).. Seven of 30 eyes of 18 patients were identified with keratitis after LASIK. The first two patients presented 12 to 14 weeks after LASIK; nontuberculous mycobacteria were identified 1 month after the flaps were cultured. Patient recall identified three additional cases by culture and two cases by clinical features alone. Pulsed-field gel electrophoresis (PFGE) was used to type the isolates, and treatment was modified based on susceptibilities.. M. szulgai was identified in five patients for whom cultures were performed, but response to empiric therapy based on cultures proved unsatisfactory. The keratitis resolved in all patients with treatment including clarithromycin based on susceptibilities. Medical therapy was sufficient, although one patient required flap amputation. Six of seven patients recovered best-corrected visual acuity (BCVA), while one patient lost one line of BCVA. Two patients lost one line of postoperative uncorrected visual acuity (UCVA), two patients gained one line of UCVA, and three patients recovered postoperative UCVA. PFGE analysis revealed that the M. szulgai strains were identical, and the infection source was contaminated ice used to chill syringes for saline lavage.. Nontuberculous mycobacterial keratitis after LASIK is a diagnostic and management challenge, but outcomes can be preserved with treatment based on susceptibilities. This cluster underscores the importance of adherence to sterile protocol during LASIK.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Equipment Contamination; Female; Humans; Keratitis; Keratomileusis, Laser In Situ; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Postoperative Complications; Risk Factors; Time Factors

A low nutrient culture medium was used to identify the pathogens in four cases of persisting ocular infection. Bacto R2A agar was used in addition to conventional liquid- and solid-phase media to culture pathogenic bacteria from one case of recurrent keratitis, one case of suture-related keratitis with endophthalmitis and two eyes (two patients) with post-operative endophthalmitis. In each case, a pathogen was identified solely with R2A agar after culture for 6 days. Species isolated were Pseudomonas aeruginosa (one), Propionibacterium acnes (two) and Staphylococcus aureus (one). Antibiotic therapy was tailored to conform to the sensitivity of the cultured organism in each case. The use of Bacto R2A low nutrient agar should be considered in culture negative eyes not showing clinical improvement, or for chronic cases where bacteria may have become adapted to more stringent ocular environments.

Topics: Aged; Amikacin; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Ciprofloxacin; Clarithromycin; Culture Media; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Keratitis; Male; Middle Aged; Propionibacterium acnes; Pseudomonas aeruginosa; Staphylococcus aureus; Vancomycin