The combination of topical ceftazidime and aminoglycosides in the treatment of refractory pseudomonal keratitis.
BACKGROUND
Pseudomonal keratitis is a serious and potentially blinding infection.


METHODS
We treated 12 patients with culture-positive fulminant pseudomonal keratitis with a topical combination of ceftazidime ophthalmic solution (50 mg/ml) and aminoglycosides (14 mg/ml). None of these patients had responded to the standard initial therapy with topical fortified gentamicin or tobramycin (14 mg/ml) combined with cefazolin (50 mg/ml).


RESULTS
Substitution of cefazolin by ceftazidime achieved a remarkable clinical improvement during the first 24-48 h of administration in all cases. The average time of healing after initiation of the combination of ceftazidime and fortified aminoglycosides was 21+/-15 days. No serious side effects accompanied ceftazidime administration. In vitro susceptibility testing showed resistance to gentamicin or tobramycin in 33% of cases (4/12) and sensitivity to ceftazidime in all cases.


CONCLUSIONS
The combination of ceftazidime, in a 5% solution, and fortified aminoglycosides (1.4%) may be a useful, safe and effective topical therapy for the treatment of pseudomonal keratitis resistant to aminoglycosides.
Robinson
A
A
Department of Ophthalmology, Rabin Medical Center, Petach-Tikva, Israel. robinson@inter.net.il
Kremer
I
I
Avisar
R
R
Gaton
D
D
Savir
H
H
Yassur
Y
Y
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002442:Ceftazidime / Q000008:administration & dosage / Q000627:therapeutic use*; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use*; D003315:Cornea / Q000382:microbiology; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007634:Keratitis / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012189:Retrospective Studies; D012449:Safety; D016896:Treatment Outcome; D014792:Visual Acuity
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D009883:Ophthalmic Solutions; D002442:Ceftazidime