title: Acanthamoeba keratitis--resistance to medical therapy.
abstract: Successful medical therapy of Acanthamoeba keratitis has been reported with combination therapy; topical Brolene and neomycin. Resistance has not so far been identified as a problem, but was the basis for recurrent disease observed in a patient with bilateral infection. Eradication of amoebae was finally achieved following prolonged topical therapy and two corneal grafts in each eye. Topical anti-amoebic therapy with paromomycin, benzethonium chloride, clotrimazole and R11/29 (a phenanthridinium compound), was continued for three months post-operatively. No further recurrences occurred during 14 months' follow-up. Drug sensitivities were performed for three isolates of Acanthamoeba sp (group II) which demonstrated the development of resistance to Brolene and arsenic. In addition, the resistant isolates were temperature-sensitive mutants which would not grow at temperatures above 30 degrees C. This could explain 'culture-negative' results in some cases of clinical recurrence when incubation of laboratory samples had only been performed at 37 degrees C.
authors.affiliation: Moorfields Eye Hospital, London.
authors.forename: L
authors.initials: L
authors.lastname: Ficker
authors.forename: D
authors.initials: D
authors.lastname: Seal
authors.forename: D
authors.initials: D
authors.lastname: Warhurst
authors.forename: P
authors.initials: P
authors.lastname: Wright
mesh_terms: D015823:Acanthamoeba Keratitis / Q000188:drug therapy* / Q000601:surgery; D000328:Adult; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D001152:Arsenicals / Q000627:therapeutic use; D001550:Benzamidines / Q000627:therapeutic use*; D001558:Benzethonium / Q000627:therapeutic use; D003022:Clotrimazole / Q000627:therapeutic use; D016039:Corneal Transplantation; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D009355:Neomycin / Q000627:therapeutic use*; D010303:Paromomycin / Q000627:therapeutic use; D010617:Phenanthridines / Q000627:therapeutic use; D012008:Recurrence; D013696:Temperature
chemical_list: D000981:Antiprotozoal Agents; D001152:Arsenicals; D001550:Benzamidines; D010617:Phenanthridines; D001558:Benzethonium; D010303:Paromomycin; C046651:propamidine isethionate; D003022:Clotrimazole; D009355:Neomycin