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B.L. Shapiro, P. Lalitha, A.W. Fothergill, J. Ruiz, M. Srinivasan, N.V. Prajna, J. Chidambaram, Y. Pan, S. McLeod, T.M. Lietman; Sensitivity of Filamentous Fungi Isolated From Fungal Keratitis to Amphotericin B, Natamycin, Caspofungin, Itraconazole, Voriconazole, and Posaconazole . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2622.
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Fungal corneal ulcers are notoriously difficult to manage, and physicians currently choose antifungal agents empirically. A range of new antifungal agents has become available that has not been widely applied in ocular disease. The non–ocular infectious disease literature has suggested that susceptibility testing of fungal isolates can provide clinically relevant information. This study aims to characterize the susceptibility of six antifungal agents against filamentous fungi cultured from scrapings of fungal keratitis.
Corneal isolates from 98 consecutive cases of culture–proven fungal keratitis presenting to the Aravind Eye Hospital were collected. Fungi were identified and tested for susceptibility to the following antifungal agents: Amphotericin B, Natamycin, Caspofungin, Itraconazole, Voriconazole, and Posaconazole. The fungal isolates were analyzed for susceptibility to antifungal agents by conducting Minimal Inhibitory Concentration (MIC) testing performed using the macrobroth dilution technique according to NCCLS guidelines set forth in NCCLS M38–A. MIC50 and MIC90 values for Fusarium spp., Aspergillus spp., and all species together were estimated.
We identified the fungal genus in 95 of the 98 specimens; the other 3 were unidentifiable or contaminated. Thirty–nine isolates were identified as Fusarium spp. and 43 as Aspergillus spp.
Table 1: Minimal inhibitory concentration of antifungal agents to filamentous fungi
No single agent was uniformly most effective for all filamentous species tested. In vitro, Posaconazole had the lowest MICs against Aspergillus spp., while Voriconazole gave the lowest MICs against Fusarium spp.. Future studies may determine how in vitro susceptibilities correlate with in vivo clinical results.
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