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D. Goldblum, B.E. Frueh, G.–M. Sarra, K. Katsoulis, S. Zimmerli; Topical Caspofungin Treatment in a Rabbit Model of Candida Keratitis . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4978.
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Purpose: To study the efficacy of topical caspofungin versus topical amphotericin B (AmB) and balanced saline solution (BSS) for the treatment of experimental Candida keratomycosis in a rabbit model. Methods: Burgundy fawn rabbits were randomly divided in 4 treatment groups: caspofungin 0.15%, caspofungin 0.5%, AmB 0.15% and BSS. Fungal keratitis was induced with a standardized inoculum of Candida albicans (SC 5314), placed on the 7 mm denuded cornea and covered with a contact lens protected by temporary tarsorrhaphy. 24 h later, topical treatment was started every 5 minutes for the first hour then repeated every 30 minutes for 11.5 hours; and, after a 12–hour pause, hourly for the following 12 hours. The animals were sacrificed 12 hours after administration of the last dose. Corneas were bisected: half were used for quantitative isolate recovery, the other for histological determination of the depth of stromal infiltration and hyphal density. Clinical grading was performed at the beginning and at the end of treatment. Results: Mean isolate recovery was 58 CFU in the 0.5% and 940 CFU in the 0.15% caspofungin group compared to 15 CFU in the AmB and 6032 CFU in the BSS group (p<0.05). Histologically, mean hyphal density was significantly lower in all groups compared to BSS whereas no statistical difference was found for stromal infiltration. Clinically, there was significant progression of depth of infiltration with BSS and caspofungin 0.15%, whereas AmB and caspofungin 0.5% inhibited further fungal spread. Conclusions: Our study suggests that topical caspofungin 0.5%, was as effective as topical AmB 0.15% in treating Candida keratitis in a rabbit model. The potential clinical effectiveness of caspofungin awaits further investigation.
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