Combined topical fluconazole and corticosteroid treatment for experimental Candida albicans keratomycosis.
OBJECTIVE
To determine the most efficient time point and concentration of topical corticosteroids in Candida albicans keratitis treated with fluconazole.


METHODS
Corneas of 105 rabbits were infected with viable yeast cells of C. albicans (2.5 x 10(5)). After a 48-hour incubation period, seven groups of animals were treated for 21 days with fluconazole, with group I acting as a control, and groups II to VII receiving adjunct therapy with the corticosteroid prednisolone (5 or 10 times daily; 3, 9, or 15 days after infection). The degree of corneal infiltration, ulceration, corneal clouding, hypopyon, conjunctivitis, neovascularization, and corneal perforation was monitored over a 24-day period, as well as recultivation and resistance to fluconazole of the C. albicans pathogen.


RESULTS
The control group showed the highest level of corneal clouding and neovascularization. In comparison, by day 24, the majority of groups also treated with prednisolone displayed significantly less corneal clouding and neovascularization. An immediate decrease in corneal clouding was observed in groups treated with additional low- or high-dose prednisolone from day 9 after inoculation. After additional prednisolone treatment from day 9 or 15 after inoculation, no significant difference was detected in the recultivation rate of C. albicans compared with the control. Early administration of prednisolone (day 3, low and high dose) resulted in the recultivation of significantly more C. albicans.


CONCLUSIONS
Fluconazole plus adjunct high-dose prednisolone treatment was most effective when administered 9 days after infection. The delayed application of corticosteroids after treatment with antimycotic drugs in cases of fungal keratitis is therefore not contraindicated and may be beneficial in patients.
Schreiber
Wolfram
W
Department of Ophthalmology, Faculty of Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
Olbrisch
Antje
A
Vorwerk
Christian K
CK
König
Wolfgang
W
Behrens-Baumann
Wolfgang
W
D000818:Animals; D000935:Antifungal Agents / Q000627:therapeutic use*; D002176:Candida albicans / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D003231:Conjunctivitis / Q000188:drug therapy / Q000473:pathology; D003315:Cornea / Q000382:microbiology; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000627:therapeutic use*; D007634:Keratitis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D009389:Neovascularization, Pathologic / Q000188:drug therapy / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use*; D011817:Rabbits; D013997:Time Factors
D000935:Antifungal Agents; D005938:Glucocorticoids; D015725:Fluconazole; D011239:Prednisolone