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In vitro comparison of combination and monotherapy for the empiric and optimal coverage of bacterial keratitis based on incidence of infection.
Cornea. 2013 Jun; 32(6):830-4.C

Abstract

PURPOSE

Cefazolin/tobramycin, cefuroxime/gentamicin, and moxifloxacin were compared using bacterial keratitis isolates to determine whether empiric therapy constituted optimal antibacterial treatment.

METHODS

Based on percent incidence of corneal infection, 27 Staphylococcus aureus, 16 Pseudomonas aeruginosa, 10 Serratia marcescens, 4 Moraxella lacunata, 3 Haemophilus influenzae, 9 coagulase-negative staphylococci, 7 Streptococcus viridans, 6 Streptococcus pneumoniae, 7 assorted Gram-positive isolates, and 11 assorted Gram-negative isolates were tested for minimum inhibitory concentrations to cefazolin, tobramycin, cefuroxime, gentamicin, and moxifloxacin using E-tests to determine susceptibility and potency.

RESULTS

The in vitro coverage (susceptible to at least one antibiotic) of cefuroxime/gentamicin (97%) was statistically equal to cefazolin/tobramycin (93%) and moxifloxacin (92%) (P = 0.29). Double coverage (susceptible to both antibiotics) was equivalent (P = 0.77) for cefuroxime/gentamicin (42%) and cefazolin/tobramycin (40%). The susceptibilities of individual coverage were moxifloxacin (92%), gentamicin (89%), tobramycin (74%), cefazolin (58%), and cefuroxime (52%). Methicillin-resistant S. aureus was best covered by gentamicin 100% (9 of 9). Tobramycin was more potent (P = 0.00001) than gentamicin for P. aeruginosa, whereas cefazolin was more potent (P = 0.0004) than cefuroxime for S. aureus.

CONCLUSIONS

Although there seems to be no in vitro empiric coverage advantage between cefazolin/tobramycin, cefuroxime/gentamicin, and moxifloxacin monotherapy, potency differences may occur and optimal treatment can best be determined with laboratory studies.

Authors+Show Affiliations

Department of Ophthalmology, UPMC Eye Center, The Charles T. Campbell Ophthalmic Microbiology Laboratory, Ophthalmology and Visual Sciences Research Center, The Eye and Ear Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. kowalskirp@upmc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23132444

Citation

Kowalski, Regis P., et al. "In Vitro Comparison of Combination and Monotherapy for the Empiric and Optimal Coverage of Bacterial Keratitis Based On Incidence of Infection." Cornea, vol. 32, no. 6, 2013, pp. 830-4.
Kowalski RP, Kowalski TA, Shanks RM, et al. In vitro comparison of combination and monotherapy for the empiric and optimal coverage of bacterial keratitis based on incidence of infection. Cornea. 2013;32(6):830-4.
Kowalski, R. P., Kowalski, T. A., Shanks, R. M., Romanowski, E. G., Karenchak, L. M., & Mah, F. S. (2013). In vitro comparison of combination and monotherapy for the empiric and optimal coverage of bacterial keratitis based on incidence of infection. Cornea, 32(6), 830-4. https://doi.org/10.1097/ICO.0b013e318268d6f4
Kowalski RP, et al. In Vitro Comparison of Combination and Monotherapy for the Empiric and Optimal Coverage of Bacterial Keratitis Based On Incidence of Infection. Cornea. 2013;32(6):830-4. PubMed PMID: 23132444.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In vitro comparison of combination and monotherapy for the empiric and optimal coverage of bacterial keratitis based on incidence of infection. AU - Kowalski,Regis P, AU - Kowalski,Tyler A, AU - Shanks,Robert M Q, AU - Romanowski,Eric G, AU - Karenchak,Lisa M, AU - Mah,Francis S, PY - 2012/11/8/entrez PY - 2012/11/8/pubmed PY - 2013/9/21/medline SP - 830 EP - 4 JF - Cornea JO - Cornea VL - 32 IS - 6 N2 - PURPOSE: Cefazolin/tobramycin, cefuroxime/gentamicin, and moxifloxacin were compared using bacterial keratitis isolates to determine whether empiric therapy constituted optimal antibacterial treatment. METHODS: Based on percent incidence of corneal infection, 27 Staphylococcus aureus, 16 Pseudomonas aeruginosa, 10 Serratia marcescens, 4 Moraxella lacunata, 3 Haemophilus influenzae, 9 coagulase-negative staphylococci, 7 Streptococcus viridans, 6 Streptococcus pneumoniae, 7 assorted Gram-positive isolates, and 11 assorted Gram-negative isolates were tested for minimum inhibitory concentrations to cefazolin, tobramycin, cefuroxime, gentamicin, and moxifloxacin using E-tests to determine susceptibility and potency. RESULTS: The in vitro coverage (susceptible to at least one antibiotic) of cefuroxime/gentamicin (97%) was statistically equal to cefazolin/tobramycin (93%) and moxifloxacin (92%) (P = 0.29). Double coverage (susceptible to both antibiotics) was equivalent (P = 0.77) for cefuroxime/gentamicin (42%) and cefazolin/tobramycin (40%). The susceptibilities of individual coverage were moxifloxacin (92%), gentamicin (89%), tobramycin (74%), cefazolin (58%), and cefuroxime (52%). Methicillin-resistant S. aureus was best covered by gentamicin 100% (9 of 9). Tobramycin was more potent (P = 0.00001) than gentamicin for P. aeruginosa, whereas cefazolin was more potent (P = 0.0004) than cefuroxime for S. aureus. CONCLUSIONS: Although there seems to be no in vitro empiric coverage advantage between cefazolin/tobramycin, cefuroxime/gentamicin, and moxifloxacin monotherapy, potency differences may occur and optimal treatment can best be determined with laboratory studies. SN - 1536-4798 UR - https://www.unboundmedicine.com/medline/citation/23132444/In_vitro_comparison_of_combination_and_monotherapy_for_the_empiric_and_optimal_coverage_of_bacterial_keratitis_based_on_incidence_of_infection_ L2 - http://dx.doi.org/10.1097/ICO.0b013e318268d6f4 DB - PRIME DP - Unbound Medicine ER -