Lim L, Coster D J, Badenoch P R
Department of Ophthalmology, Flinders University of South Australia, Bedford Park, Australia.
Clin Exp Ophthalmol. 2000 Apr;28(2):119-24. doi: 10.1046/j.1442-9071.2000.00275.x.
To determine the in vitro drug susceptibility of Australian corneal isolates of Acanthamoeba and to correlate the results with patient treatment and visual outcome.
Acanthomoeba isolates were obtained from a reference laboratory Cyst suspensions were prepared from 19 strains and exposed to 10 antimicrobial agents for 7 days. The minimum drug concentrations required to inhibit excystation were determined. Inhibited cells were then plated out to determine minimum cysticidal concentrations.
Overall, propamidine proved to be the most active anti-Acanthamoeba agent tested. The disinfectant polyhexamethylene biguanide, either pure or in Baquacil, was also effective. Pentamidine, hexamidine, chlorhexidine and chloroxylenol had intermediate activity, while neomycin, amphotericin B and povidone-iodine had poor activity. There was no clear relationship between in vitro susceptibility and visual outcome.
Propamidine and polyhexamethylene biguanide drops are recommended as initial choices for the treatment of Acanthamoeba keratitis. The variability in the susceptibility to any one agent suggests that individual testing of isolates is necessary to identify the most appropriate treatment. A number of factors influence visual outcome in these cases; further studies are required to resolve the importance or otherwise of in vitro susceptibility.
确定澳大利亚棘阿米巴角膜分离株的体外药敏情况，并将结果与患者治疗情况及视力转归相关联。
从一家参考实验室获取棘阿米巴分离株。由19个菌株制备包囊悬液，并使其接触10种抗菌药物7天。确定抑制脱囊所需的最低药物浓度。然后将受抑制的细胞进行平板接种以确定最低杀囊浓度。
总体而言，喷他脒被证明是所测试的最有效的抗棘阿米巴药物。消毒剂聚六亚甲基双胍，无论是纯品还是在百可得中，也都有效。戊烷脒、己脒、洗必泰和氯二甲酚具有中等活性，而新霉素、两性霉素B和聚维酮碘活性较差。体外药敏情况与视力转归之间没有明确的关系。
推荐使用喷他脒和聚六亚甲基双胍滴眼液作为棘阿米巴角膜炎治疗的初始选择。对任何一种药物的药敏变异性表明，有必要对分离株进行个体检测以确定最合适的治疗方法。在这些病例中，有许多因素影响视力转归；需要进一步研究以明确体外药敏的重要性与否。
