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Treating fungal keratitis is difficult. Most antifungal medications are merely fungistatic, and require an intact immune system and prolonged therapeutic course. Except for Natacyn (natamycin 5%, Alcon), all antifungal medications must be adapted for ophthalmic use from systemic drugs. The result: considerable ophthalmic toxicity. $ ? L: W q: _! @9 ?: R, d* `
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Drug classes used to treat fungal keratitis include the polyene antibiotics (nystatin, amphotericin B, natamycin); pyrimidine analogs (flucytosine); imidazoles (clortrimazole, miconozole, ketoconazole); triazoles (fluconazole, itraconazole); and silver sulfadiazine. Steroids are contraindicated; they will exacerbate the disease. For filamentary fungal infections, topical Natacyn is the first choice. Alternatives include amphotericin B 0.15% and flucytosine 1% 150 mg/kg--the same therapy for yeast infections. An alternative treatment in yeast infections is fluconazole 0.5% 200 mg and miconozole 1%. All therapies are indicated hourly around the clock. |
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