Use of clotrimazole eye Suspension for fungal keratitis as monotherapy or sequentially with amphotercin-B

Abstract

Aim: To determine the efficacy of 1% clotrimazole eye drops suspension for treating fungal keratitis as monotherapy or sequentially with topical amphotercin-B.Method:This therapeutic trial was conducted in Ibn Al-Haetham Teaching Eye Hospital/Baghdad between February 2008 and July 2009. The patients with culture proven fungal keratitis were divided into two groups, first group (presented between February 2008 and May 2008) were treated initially with 1% clotrimazole eye suspension. Second group (presented between May 2008 and July 2009) were treated sequentially with 0.1% amphotercin-B eye drops (induction phase) for 2-3 weeks, then switched to 1% clotrimazole eye suspension (maintenance phase). The results in the sequential group were compared with a previous study of using 0.1% amphotercin-B eye drops as monotherapy for treating fungal keratitis. Results: Thirty-two patients with culture proven fungal keratitis were enrolled in this study. Eight cases treated initially with clotrimazole suspension, only two of them had favorable response. While 24 patients treated sequentially and 20 of them had favorable response. Comparing the sequential therapy with a previous study used 0.1% amphotercin eye drops as monotherapy, showed that mean time for therapy was not significantly different in non-severe cases (4.1/4 weeks), while it was shorter in severe cases (9.5/12 weeks).Conclusion: Use of clotrimazole eye drops as monotherapy is not effective in treating fungal keratitis. While Sequential therapy of using topical amphotercin-B during induction phase followed by 1% clotrimazole suspension as clearance, or maintenance phase is an effective and cheaper therapy for treating fungal keratitis.