3 Antimicrobial

Question 1

Bacterial keratitis
Low risk of vision loss:

Answer 1

Low risk of vision loss:
Small, peripheral infiltrate, no or minimal AC reaction, no discharge
* Fluoroquinolone(e.g. moxifloxacin ) q1 q1-2 hours
* Consider ointment (e.g. ciprofloxacin) qhs
* Once improvement, qid until resolved
* Cycloplegic drop if needed for pain

Question 2

Bacterial keratitis
Borderline risk of vision loss :

Answer 2

Borderline risk of vision loss: medium size (< 2mm), peripheral
defect, epithelial defect, mild AC reaction, moderate discharge
* Fluoroquinolone (e.g. moxifloxacinmoxifloxacin)
* Loading dose q5 min for 30 min,
then q1 hour around the clock
* Once improving q2h while awake & ointment qhs
* Reduce to qid until completely resolved
* Cycloplegic drop and/or oral pain medication

Question 3

Bacterial keratitis
Vision threatening:

Answer 3

Vision threatening: size >2mm, within the visual axis,
significant AC reaction and discharge
* Fortified antibiotics
* Loading dose
* Atropine 1% tid for pain and to prevent synechiae
* Oral pain medications
* IV or oral antibiotics may be added in some severe cases
* Patient may be admitted to the hospital if sight threatening,
difficulty instilling drops, poor compliance, IV antibiotics are
needed

Question 4

Bacterial keratitis
Follow-up:

Answer 4

Daily evaluation at first until significant improvement
* Check visual acuity, and symptoms, measure the size of infiltrate and epithelial defect, anterior
chamber reaction

Antibiotic frequency is gradually decreased but never tapered past the
minimum dose to inhibit the emergence of resistance (usually qid )

The patient is advised to return immediately if increase in pain, a decrease in vision, or the size of the ulcer increases!

Question 5

Chlamydial conjunctivitis

Answer 5

Preferred: oral azithromycin 1g p.o. single dose
Alternative: oral doxycycline p.o. 100mg bid for 1 week
Adjunct topical Tx: erythromycin or tetracycline ung bid or tid x 3 weeks

Question 6

Trachoma

Answer 6

Systemic: Azithromycin 1g single dose (adults)
20 mg/kg single dose (children over 6 months)

Alternative therapies: tetracycline 250mg qid for 2 weeks or
doxycycline 100mg bid for 3 weeks

Topical: tetracycline 1% ointment bid for 6 weeks