Ficker L, Seal D, Warhurst D, Wright P
Moorfields Eye Hospital, London.
Eye (Lond). 1990;4 ( Pt 6):835-8. doi: 10.1038/eye.1990.132.
Successful medical therapy of Acanthamoeba keratitis has been reported with combination therapy; topical Brolene and neomycin. Resistance has not so far been identified as a problem, but was the basis for recurrent disease observed in a patient with bilateral infection. Eradication of amoebae was finally achieved following prolonged topical therapy and two corneal grafts in each eye. Topical anti-amoebic therapy with paromomycin, benzethonium chloride, clotrimazole and R11/29 (a phenanthridinium compound), was continued for three months post-operatively. No further recurrences occurred during 14 months' follow-up. Drug sensitivities were performed for three isolates of Acanthamoeba sp (group II) which demonstrated the development of resistance to Brolene and arsenic. In addition, the resistant isolates were temperature-sensitive mutants which would not grow at temperatures above 30 degrees C. This could explain 'culture-negative' results in some cases of clinical recurrence when incubation of laboratory samples had only been performed at 37 degrees C.
已有报道称联合使用局部用溴己新和新霉素治疗棘阿米巴角膜炎取得了成功。目前尚未发现耐药性是一个问题，但它是一名双侧感染患者复发性疾病的根源。在每只眼睛进行长时间的局部治疗和两次角膜移植后，最终实现了阿米巴的根除。术后继续使用巴龙霉素、苄索氯铵、克霉唑和R11/29（一种菲啶化合物）进行局部抗阿米巴治疗三个月。在14个月的随访期间未再发生复发。对三株棘阿米巴属（II组）菌株进行了药敏试验，结果显示它们对溴己新和砷产生了耐药性。此外，耐药菌株是温度敏感型突变体，在高于30摄氏度的温度下无法生长。这可以解释在一些临床复发病例中，当实验室样本仅在37摄氏度下培养时出现“培养阴性”结果的原因。
