New keratitis therapies show promise

New Orleans-Though fluoroquinolones remain mainstays for treating infectious keratitis, new medical therapies are emerging, said Eduardo C. Alfonso, MD.

“For bacterial keratitis, fluoroquinolones will continue to be developed into antibiotics that we will use with fortifications, in increasing concentrations of other antibiotics,” said Dr. Alfonso, professor and chairman, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami.

Fortifications expand the toxicity of the floroquinolones, which, he said, is the most powerful group of antibiotics developed in medicine.

“For the eye, they have been wonderful, especially in regard to the fourth-generation fluoroquinolones in treating bacterial keratitis,” he said.

These include moxifloxacin, gatifloxacin, and besifloxacin.

Moxifloxacin, he said, has the best cure rate, and is better against Gram positives, whereas gatifloxacin is better against the Gram negatives. Besifloxacin is the newest, with no systemic use, and is more active than other fluoroquinolones versus resistant organisms.

Although still rare compared with bacterial keratitis, fungal keratitis cases cannot be overlooked, he said.

In the realm of fungal keratitis and Acanthamoeba keratitis, Dr. Alfonso said he believes molecular diagnosis will target therapy more precisely, as crosslinking holds great promise.

For fungal keratitis, several antifungal agents are available: commercially prepared natamycin, extemporaneously prepared voriconazole, amphotericin, fluconazole, itraconazole, caspofungin, and posaconazole.

A future treatment being developed is mycotoxin inhibition, Dr. Alfonso added. 

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