Fluoroquinolone may be realistic therapy for MRSA keratitis
Patients treated with a fourth-generation fluoroquinolone for MRSA keratitis experienced similar visual acuity outcomes as those treated with vancomycin, according to a presenter at the virtual Association for Research in Vision and Ophthalmology meeting.
“Given the concern for antibiotic resistance, as well as corneal toxicity from fortified vancomycin, fluoroquinolone therapy for MRSA keratitis may be a reasonable initial treatment option with close monitoring,” Sarah Atta, BS, said.
Atta and colleagues evaluated 52 culture-proven cases of MRSA keratitis from 2008 to 2019 at the University of Pittsburgh Medical Center. The researchers analyzed the clinical characteristics, management choices and outcomes of 36 eyes initially treated with fluoroquinolone and 16 eyes initially treated with vancomycin.
The average presenting logMAR visual acuity was 1.59 in the fluoroquinolone group and 1.94 in the vancomycin group, which was not a statistically significant difference. The mean follow-up was 370.72 days in the fluoroquinolone group compared with 239.56 days in the vancomycin group.
At final-follow up, logMAR visual acuity was 1.16 in the fluoroquinolone group compared with 1.36 in the vancomycin group, which was not a statistically significant difference.
“Patients treated with fluoroquinolone had comparable outcomes to those treated with fortified vancomycin; however, those treated with fortified vancomycin tended to have more severe ulcers at presentation,” Atta said.
Patients treated with vancomycin were also more likely to present with hypopyon than those treated with fluoroquinolone, 46.7% vs. 15.4%, and be admitted for treatment.
There were no statistically significant differences between the treatment cohorts for adjunctive treatment or for procedures such as tarsorrhaphy, debridement, penetrating keratoplasty or enucleation.
Atta S. Methicillin-resistant Staphylococcus aureus (MRSA) keratitis: An analysis of outcomes of cases treated initially with vancomycin versus cases treated with fluoroquinolone drops. Presented at: Presented at: Association for Research in Vision and Ophthalmology annual meeting; May 6, 2020 (virtual meeting).