Initial therapy for suppurative microbial keratitis in Iraq.
OBJECTIVE
To provide data-based guidelines for selection of an appropriate initial therapy for management suppurative microbial keratitis (SMK) in Iraq.


METHODS
This case-series study enrolled patients with clinical signs of suppurative keratitis suspected of being microbial, presented prospectively at Ibn Al-Haetham Teaching Eye Hospital from April 2002 to March 2005. Predisposing factors, microbial profile and sensitivities of isolated bacteria were determined. If direct microscopic examination of smears was negative for fungal elements, initial therapy started with ciprofloxacin 0.3% eye-drops. Subsequent treatment depends on clinical response and cultures' results.


RESULTS
Out of 396 cases enrolled, positive cultures were obtained in 232 cases (58.6%). The predominating agents isolated were Gram-positive cocci (Staphylococcus and Streptococcus) 75 cases (18.9%); Pseudomonas 68 cases (17.2%); and fungal species 74 cases (18.7%). Treatment was initiated with ciprofloxacin eye-drops in 364 cases, a favourable response was recorded in 185 cases (50.8%), addition of other antimicrobial drugs was required in 56 cases (15.4%), while failure of treatment was recorded in 123 cases (33.8%).


CONCLUSIONS
Use of ciprofloxacin eye drops alone as an initial therapy cannot cover most of the causative agents of SMK in Iraq. Addition of another drug can provide a better coverage for the predominating causative agents. The choice of this additional drug is based on the suspected infecting agent depending on the regional predisposing factors, and the clinical features.
Al-Shakarchi
Faiz
F
Ibn Al-Haetham Teaching Eye Hospital, BGW, Baghdad, Iraq. faizalshkr@yahoo.com
D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000209:etiology; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D007493:Iraq; D007634:Keratitis / Q000209:etiology / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000188:drug therapy; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy; D013290:Streptococcal Infections / Q000188:drug therapy; D013492:Suppuration; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D009883:Ophthalmic Solutions; D002939:Ciprofloxacin