title: Comparing the ocular surface effects of topical vancomycin and linezolid for treating bacterial keratitis.
abstract: BACKGROUND
  Vancomycin is the gold standard in combination therapy for severe and resistant gram-positive keratitis and in particular for Methicillin-resistant Staphylococcus aureus (MRSA) infections. The aim of this study was to report the ocular surface toxicity and scoring in patients whose treatment shifted to topical linezolid/ceftazidime from topical vancomycin/ceftazidime due to their vancomycin intolerance.
  
  
  METHODS
  A retrospective, interventional case series of bacterial keratitis was treated with topical linezolid (one drop of 0.2% solution per eye), administered hourly until epithelization and then gradually decreased. The number and extent of punctate epithelial erosions were noted across the entire surface of the cornea. Ocular discomfort was assessed by means of (a) patient-reported pain upon instillation of the medication (vancomycin/linezolid), (b) reported burning sensation between doses and (c) reported foreign-body sensation. No ocular surface toxicity related to linezolid use was noted. Patients were followed for at least 2 months after treatment between April and December 2013.
  
  
  RESULTS
  Of the seven patients included in the study (age range: 2-88 years; five females, two males), complete epithelization and resolution was achieved in five patients. One patient was treated with linezolid after penetrating keratoplasty. The second culture of another patient with impending perforation despite linezolid/ceftazidime therapy yielded Fusarium spp., so he underwent tectonic keratoplasty. The mean ocular surface score was 9.4 ± 1.6 during vancomycin treatment and 5.9 ± 1.3 during linezolid treatment after discontinuation of vancomycin. The topical linezolid score was significantly lower (p = 0.027).
  
  
  CONCLUSIONS
  Topical linezolid may be better tolerated, according to the mean ocular surface score, than topical vancomycin by some patients and can be considered an alternative for patients who do not well tolerate vancomycin.
authors.affiliation: a Department of Ophthalmology , School of Medicine, Uludag University , Bursa , Turkey.
authors.forename: Berna
authors.initials: B
authors.lastname: Akova Budak
authors.affiliation: a Department of Ophthalmology , School of Medicine, Uludag University , Bursa , Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Baykara
authors.affiliation: a Department of Ophthalmology , School of Medicine, Uludag University , Bursa , Turkey.
authors.forename: Sertaç Argun
authors.initials: SA
authors.lastname: Kıvanç
authors.affiliation: a Department of Ophthalmology , School of Medicine, Uludag University , Bursa , Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Yilmaz
authors.affiliation: a Department of Ophthalmology , School of Medicine, Uludag University , Bursa , Turkey.
authors.forename: Serhat
authors.initials: S
authors.lastname: Cicek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002675:Child, Preschool; D005123:Eye / Q000187:drug effects* / Q000473:pathology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007634:Keratitis / Q000188:drug therapy* / Q000473:pathology; D000069349:Linezolid / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D014640:Vancomycin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D000069349:Linezolid
keywords: Keratitis; linezolid; vancomycin