|Year : 1982 | Volume
| Issue : 4 | Page : 249-250
A comparative evaluation of Nystatin, Amphotercin-B and Miconazole in Keratomycosis
P Ranga Reddy, P Siva Reddy, A Raghava Reddy, NK Saboo
Institute of Ophthalmology, Sarojini Devi Eye Hospital, Hyderabad, India
P Ranga Reddy
Institute of Ophthalmology, Sarojini Devi Eye Hospital, Hyderabad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Reddy P R, Reddy P S, Reddy A R, Saboo N K. A comparative evaluation of Nystatin, Amphotercin-B and Miconazole in Keratomycosis. Indian J Ophthalmol 1982;30:249-50
Mycotic corneal ulcers are occurring more frequently due to injudicious use of broad spectrum antibiotics and corticosteroids. More than 1000 different species of fungi are known and of these nearly 100 species from 50 genera have been said to effect the human eye. Earlier few cases were described however until more recent years; when from 1950 onwards increasing number of accounts of Mycotic infections have appeared in literature. This increase in incidence has been closely associated to greater clinical awareness, better diagnostic facilities, and the indiscriminate use of corticosteroids and antibiotics (Thygeson-1953).
In the literature there are a number of reports regarding the efficacy of topical use of various antimycotic drugs, Kaufmann and Wood found Thiomersol; Jones et al I used Pimarcin as an effective agent in Keratomycosis. Jones et al, Wood and Willeford have made trials with Amphotercin-B drops.
We have made an attempt as a clinical trial with the following drugs.
a) Nystatin (Mycostain) (Sarabhai)
b) Amphotercin-B (Fungizone) (Sarabhai)
c) Miconazole (Gufic Lab.)
| Materials and methods|| |
The study was carried out at the Institute of Ophthalmology and Sarojini Devi Eye Hospital, Hyderabad. All the cases were admitted into the corneal unit. Apart from the routine examination as soon as the cases were admitted conjunctival awabs and corneal scrapings were examined under the microscope with 10% potassium hydroxide and lactephenol cotton blue, for the identification of hyphae. Cultures were carried out in all the cases of corneal ulcers which had the clinical appearance and positive microscopic examination of hyphae. Cultures were carried out on Sabourauds' Agar medium. All the patients were divined into three categories with a control group for the clinical trials (only positive culture proved cases were taken into the study). Apart from routine treatment, the antimycotic drugs used in the treatment are as follows
a) Nystatin -1 Lac units/ml. drops in 30 pts. 5000 units Sub-conjunctivally
b) Amphotercin-B I mg/.ml. drops in 20 pts. 125 mg. Sub-conjunctivally
c) Miconazole-2% Ointment locally in 35 pts.
70% of patients gave history of trauma out of which 80% had agricultural injury ; 62% used local corticosteroids and antibiotics and 12 patients were referred to us as the ulcers were not responding to the routine ulcer cornea treatment from elsewhere. On an average the treatment was carried out for 6 to 10 weeks.
Selection of cases into particular category of drug usage was purely the background knowledge of Mycotic agents and a error and trial method at random. We had no rationale that a particular patient should be treated with a particular mycotic drug. This was decided as soon as microscopic examination of scraping. All the cases were studied with a control group.
The response to treatment was noted everyday.
Drops were used hourly, from 6 A.M. to 10.00 P.M. (Nystatin and Amphotercin-B) and ointment (Miconazole) 4 times daily. Nystatin and Amphotercian-B were also given with subconjunctivally for 10 -12 days.
| Observations and discussion|| |
Early reproting of the cases diagnosis and treatment are the important factors in the prevention of corneal blindness of which Mycotic Keratitis formed a major group Keratomycosis is more seen in rural and economically weaker sections of the agriculture population.
Nystatin is a easily available drug with absolutely no side effects when given locally as ocular drops and subconjunctivally injection. It is observed that they were more active against candida; superficial ulcers and early cases. In our study it was successful to 53.33%. Amphoterician with its wide antifun. gal activity and minimal side effects (Irritation and chemosis) was successful to 65% Miconazole as 2% ointment with minimal side effects was effective to the tune of 34.28% more active against Aspergillus.
| Summary|| |
Clinical trials were carried out with Nystatin (30 cases) Amphotercian-B (20 cases) and Miconazole (35 cases) with 53.33% and 65% and 34.28% of success respectively in Keratomycosis.
| References|| |
Jones, B.R. 1969,-Trans Ophthalmol. U.K. 89,887.
Duke Elder S., 1969, System of Ophthalmology, Vol. VII-488.
Chaddah, M.R. and Aggarwal, D.C. 1978, Ind. J. Ophthalmol.26: 19.
Reddy, P.S., Satyendran, O.M., Salapaihv,M, Kumar, M.V. and Reddy P.R. 1972, Ind. J. Ophthalmol. 20: 101.
[Table - 1], [Table - 2]