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M.–K. Kim, P. Botelho, C. Zhang, J. Dick, N. Lee, J. Lee, E. Donnenfeld, T.P. O'Brien; Comparative Efficacy of Topical Mupirocin With Ciprofloxacin, Gatifloxacin and Vancomycin in the Treatment of Experimental Ciprofloxacin– and Methicillin–Resistant Staphylococcus Aureus Keratitis . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3567.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the comparative efficacy of topical mupirocin with vancomycin, gatifloxacin, and ciprofloxacin against high–level ciprofloxacin–resistant MRSA in vitro and in an animal model of keratitis.
In vitro susceptibility testing by E test was conducted to determine the minimal inhibitory concentration (MICs) for mupirocin 20 mg/ml, linezolid 20 mg/ml, vancomycin 31 mg/ml, ciprofloxacin 3 mg/ml, gatifloxacin 3 mg/ml, quinupristin–dalfopristin (Synercid) 3 mg/ml and moxifloxacin 5 mg/ml against a clinical strain of Staphylococcus aureus known to resistant to ciprofloxacin and methicillin (MRSA). Experimental keratitis was induced via intrastromal inoculation of the ciprofloxacin–resistant and MRSA in a rabbit model. Forty–five rabbits were randomly divided into 5 groups and each group was treated hourly for 12 hours with topical 0.9% balanced salt solution, 0.3% ciprofloxacin hydrochloride, 0.3% gatifloxacin, 2% mupirocin and vancomycin (25 mg/mL). Corneas were excised, homogenized and serial dilutions plated in duplicate for incubation. Antibacterial efficacy of each regimen was determined by quantitative bacteriologic analysis after 24 hours at 35°C.
Mupirocin demonstrated high activity against ciprofloxacin–resistant MRSA in vitro. The ranges of MICs are 0.064 mg/l for mupirocin and 0.094–0.25 mg/l for quinupristin–dalfopristin (Synercid) and 1–1.5 mg/l for vancomycin. Treatment with 0.3% gatifloxacin, 2% mupirocin, and vancomycin (31 mg/mL) reduced the number of MRSA more significantly than the controls and those treated with a 0.3% ciprofloxacin (P<0.05), suggesting equal effectiveness in therapy for ciprofloxacin–resistant MRSA keratitis.
These results suggest that topical mupirocin can be a potential antibacterial agent for treatment of ciprofloxacin (MIC> 32 mg/l) resistant MRSA keratitis.
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