Therapeutic agents and biocides for ocular infections by free-living amoebae of Acanthamoeba genus.
Acanthamoeba keratitis is a sight-threatening infectious disease. Resistance of the cystic form of the protozoan to biocides and the potential toxicity of chemical compounds to corneal cells are the main concerns related to long-term treatment with the clinically available ophthalmic drugs. Currently, a limited number of recognized antimicrobial agents are available to treat ocular amoebic infections. Topical application of biguanide and diamidine antiseptic solutions is the first-line therapy. We consider the current challenges when treating Acanthamoeba keratitis and review the chemical properties, toxicities, and mechanisms of action of the available biocides. Antimicrobial therapy using anti-inflammatory drugs is controversial, and aspects related to this topic are discussed. Finally, we offer our perspective on potential improvement of the effectiveness and safety of therapeutic profiles, with the focus on the quality of life and the advancement of individualized medicine.
Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Linda Christian
LC
Carrijo-Carvalho
Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Viviane Peracini
VP
Sant'ana
Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Annette Silva
AS
Foronda
Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Denise
D
de Freitas
Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil. Electronic address: frscarvalho@unifesp.br.
Fabio Ramos
FR
de Souza Carvalho
D000048:Acanthamoeba; D015823:Acanthamoeba Keratitis / Q000188:drug therapy* / Q000469:parasitology; D000656:Amoeba / Q000302:isolation & purification*; D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D004202:Disinfectants / Q000627:therapeutic use*; D015822:Eye Infections, Parasitic / Q000188:drug therapy* / Q000469:parasitology; D006801:Humans
D000981:Antiprotozoal Agents; D004202:Disinfectants
Acanthamoeba keratitis; PHMB; biguanides; chlorhexidine; cornea; diamidines; eye drops; hexamidine; propamidine