|
Fungal Keratitis
q3 f9 H( {3 E1 c ' j! z/ l& `$ b/ B) F+ b) j
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.
) F" _7 i8 n3 I% B( b/ `( L' s
( w: [( m" F; X3 _8 dDrug 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. |
|