Re-appraisal of topical 1% voriconazole and 5% natamycin in the treatment of fungal keratitis in a randomised trial.
OBJECTIVE
To compare the efficacy of topical 1% voriconazole vs 5% natamycin for the treatment of fungal keratitis.


METHODS
In a prospective, double-masked, randomised, controlled, registered clinical trial, 118 patients with fungal keratitis were treated using identical dosage schedule with either voriconazole (58) or natamycin (60) as inpatients for 7 days and followed up weekly. The outcome measures were percentage of patients with healed or resolving ulcer and final visual acuity at last follow-up (primary) and on day 7 (secondary) in each group.


RESULTS
More patients (p=0.005) on natamycin (50/56, 89.2%) had healed or resolving ulcer compared with voriconazole (34/51, 66.6%) at last follow-up. The improvement in vision was marginally greater in patients in the natamycin group compared with the voriconazole group at day 7 (p=0.04) and significantly greater at final visit (p=0.01). In univariate analysis, drug, age and mean size of corneal infiltrate and epithelial defect had a significant effect on the final visual outcome. In multivariate analysis, the effect of drug (voriconazole vs natamycin, adjusted coefficient 0.27 (-0.04 to 0.57), p=0.09) was marginal while the effect of age and epithelial defect was significant (p<0.001 for both). In the group treated with natamycin, the final visual acuity was significantly better (p=0.005, Wilcoxon signed-rank test) in patients with Fusarium keratitis but not with Aspergillus keratitis (p=0.714, paired t test).


CONCLUSIONS
When compared with voriconazole, natamycin was more effective in the treatment of fungal keratitis, especially Fusarium keratitis.


BACKGROUND
Clinical Trial Registry India (2010/091/003041).
L V Prasad Eye Institute, Bhubaneswar, Odisha, India L V Prasad Eye Institute, Brien Holden Eye Research Center, Hyderabad, Andhra Pradesh, India.
Savitri
S
Sharma
L V Prasad Eye Institute, Bhubaneswar, Odisha, India.
Sujata
S
Das
L V Prasad Eye Institute, Bhubaneswar, Odisha, India.
Ajoy
A
Virdi
L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India.
Merle
M
Fernandes
L V Prasad Eye Institute, Bhubaneswar, Odisha, India.
Srikant K
SK
Sahu
L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India.
Nagendra
N
Kumar Koday
L V Prasad Eye Institute, Brien Holden Eye Research Center, Hyderabad, Andhra Pradesh, India.
Md Hasnat
MH
Ali
L V Prasad Eye Institute, Brien Holden Eye Research Center, Hyderabad, Andhra Pradesh, India.
Prashant
P
Garg
L V Prasad Eye Institute, Brien Holden Eye Research Center, Hyderabad, Andhra Pradesh, India.
Swapna R
SR
Motukupally
D000287:Administration, Topical; D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage*; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology; D004311:Double-Blind Method; D015821:Eye Infections, Fungal / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010866:Natamycin / Q000008:administration & dosage*; D009883:Ophthalmic Solutions; D011446:Prospective Studies; D014792:Visual Acuity; D065819:Voriconazole / Q000008:administration & dosage*
D000935:Antifungal Agents; D009883:Ophthalmic Solutions; D010866:Natamycin; D065819:Voriconazole
Cornea; Drugs; Infection; Microbiology