title: Comparison of topical itraconazole 1% with topical natamycin 5% for the treatment of filamentous fungal keratitis.
abstract: OBJECTIVE
  To compare the clinical efficacy of itraconazole 1% eyedrops with a standard therapy regimen (natamycin 5% eyedrops) for topical monotherapy of fungal keratitis.
  
  
  METHODS
  Patients presenting with suspected uniocular microbial keratitis over a period of 12 months (January to December 2002) underwent detailed clinical examination and microbiological investigation. One hundred consecutive patients with direct smear- and/or culture-proven fungal keratitis were enrolled in the study after obtaining informed consent. The ulcers were categorized as severe or nonsevere. The first 50 consecutive patients received primary therapy with topical natamycin hourly, and the next 50 consecutive patients received topical itraconazole hourly. The primary efficacy criteria were the physician's judgment of clinical success, cure rate, and the rate of treatment failure.
  
  
  RESULTS
  The diagnosis of fungal keratitis was established by positive microscopy and culture findings in 88 patients and by positive microscopy alone in 12 patients. Species of Fusarium, Aspergillus, and Curvularia were the principal isolates. Thirty-six (72%) of 50 patients (28 of 37 with nonsevere keratitis and 8 of 13 with severe keratitis) showed a favorable response to primary natamycin therapy (mean duration, 20.5 days), while 30 (60%) of 150 patients (25 of 38 with nonsevere keratitis and 5 of 12 with severe keratitis) exhibited a favorable response to primary itraconazole therapy (mean duration, 23.1 days). In keratitis due to Fusarium spp, 19 (79%) of 24 patients showed a favorable response to natamycin, which was significantly greater than the 8 (44%) of 18 patients who showed a favorable response to itraconazole (P < 0.02). However, no such difference was evident in keratitis due to Aspergillus spp or Curvularia spp; in keratitis due to Aspergillus spp, favorable responses were noted in 6 (54.5%) of 11 patients receiving natamycin and 5 (50%) of 10 patients receiving itraconazole, while in keratitis due to Curvurlaria spp, such responses occurred in both patients receiving natamycin and in 8 (89%) of 9 patients receiving itraconazole. Both antifungal formulations were generally well tolerated with no obvious adverse effects.
  
  
  CONCLUSIONS
  Topical natamycin should continue to be considered as the treatment of choice for filamentous fungal keratitis; when natamycin is unavailable, topical itraconazole therapy could be used, particularly if the infections are due to Aspergillus or Curvularia spp.
authors.affiliation: Institute of Ophthalmology, Joseph Eye Hospital, Tamil Nadu, India.
authors.forename: C M
authors.initials: CM
authors.lastname: Kalavathy
authors.forename: Pragya
authors.initials: P
authors.lastname: Parmar
authors.forename: J
authors.initials: J
authors.lastname: Kaliamurthy
authors.forename: Vinitha Rachel
authors.initials: VR
authors.lastname: Philip
authors.forename: M D K
authors.initials: MD
authors.lastname: Ramalingam
authors.forename: C A Nelson
authors.initials: CA
authors.lastname: Jesudasan
authors.forename: Philip A
authors.initials: PA
authors.lastname: Thomas
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy; D002648:Child; D015821:Eye Infections, Fungal / Q000188:drug therapy*; D005260:Female; D005670:Fusarium; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage* / Q000627:therapeutic use; D007634:Keratitis / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D003904:Mitosporic Fungi; D010866:Natamycin / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D010866:Natamycin