role of pretreatment microbiologic study in the management of suspended infectious keratitis

ABSTRACT

Sixty-five cases of suspected infectious keratitis not receiving treatment were studied. All patients were subjected to full ophthalmological examination and pretreatment microbiologic studies. All eyes were treated with topical fortified tobramycin and chloramphenicol eye drops. Comparisons of the results of gram stain and cultures were recorded. Fifty cases produced positive bacterial isolates [32 in single form and 18 were mixed]. Fungal isolates were positive in five cases [three in pure form and two mixed with bacteria]. Sixty cases had complete resolution with initial therapy. Modification of antibiotic therapy succeeded in treating another two eyes. Three cases with pure fungal infection improved on antifungal therapy. The two eyes with mixed fungal infection resolved on antibiotic therapy alone. It was concluded that for small, superficial, peripheral corneal ulcers without associated risk factors or suspected fungal infection, the treatment with carefully selected broad spectrum antibiotics at frequent intervals with close follow up is recommended. For otherwise cases complete pretreatment microbiologic examination is recommended followed by medical therapy guided by the microbiologic results: