Initial therapy for suppurative microbial keratitis in Iraq

Abstract

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%).

Conclusion: 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.