title: Use of Topical Besifloxacin in the Treatment of Mycobacterium chelonae Ocular Surface Infections.
abstract: OBJECTIVE
  To present the clinical outcome of 3 cases of ocular surface infections by Mycobacterium chelonae treated with besifloxacin (0.6%, Besivance; Bausch & Lomb, Tampa, FL).
  
  
  METHODS
  In this retrospective review of a small case series, we reviewed the medical records of 3 clinical patients with M. chelonae infection involving the ocular surface. Besifloxacin was used as an adjunct in 2 cases of keratitis and as the principal therapeutic agent in a case of nodular conjunctivitis.
  
  
  RESULTS
  Two patients who presented with culture-proven M. chelonae keratitis initially had been treated with topical amikacin and oral clarithromycin for 6 months in the first case and for 2 months in the second without complete resolution. Topical besifloxacin was added as an adjunct therapy to amikacin with progressive weaning of clarithromycin. Both cases of keratitis eventually resolved without recurrence after discontinuation of topical amikacin and besifloxacin. A third patient presented with nodular conjunctival inflammation, which initially had been treated with topical ciprofloxacin and corticosteroids without improvement. One nodular lesion was excised and submitted for microbial culture, which revealed the growth of M. chelonae. Marked improvement of the conjunctivitis was noted after 3 weeks of treatment with topical besifloxacin. Complete resolution of the conjunctival nodules was achieved after 10 weeks of treatment with besifloxacin.
  
  
  CONCLUSIONS
  Topical besifloxacin seems to be a useful adjunct agent in the treatment of nontuberculous mycobacterial keratitis by M. chelonae and may be viable for use as a first-line agent in cases of nodular conjunctivitis by M. chelonae.
authors.affiliation: *Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT; and †Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St Louis, St Louis, MO.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Nguyen
authors.forename: Augustine R
authors.initials: AR
authors.lastname: Hong
authors.forename: Jeanine
authors.initials: J
authors.lastname: Baqai
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Lubniewski
authors.forename: Andrew J W
authors.initials: AJ
authors.lastname: Huang
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001381:Azepines / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy* / Q000382:microbiology; D016926:Mycobacterium chelonae / Q000302:isolation & purification*; D009883:Ophthalmic Solutions; D012189:Retrospective Studies; D059005:Topoisomerase II Inhibitors / Q000627:therapeutic use*; D014792:Visual Acuity / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D001381:Azepines; D024841:Fluoroquinolones; D009883:Ophthalmic Solutions; D059005:Topoisomerase II Inhibitors; D000583:Amikacin; C522124:besifloxacin; D017291:Clarithromycin