Jones D B
Ophthalmology. 1981 Aug;88(8):814-20. doi: 10.1016/s0161-6420(81)34943-4.
The successful management of suppurative microbial keratitis requires five steps: (1) make the clinical diagnosis, (2) perform the proper laboratory procedures, (3) initiate antimicrobial therapy, (4) modify the initial therapy, and (5) terminate therapy. The most helpful guidelines to decision-making in these steps are: (1) the clinical impression, (2) severity of keratitis, (3) results of laboratory studies, (4) disease potential of the responsible organism, and (5) effectiveness and toxicity of various antimicrobial agents. Selection of initial antibiotics ideally should be directed by interpretation of the corneal smears. The preferred initial antibiotic for keratitis caused by a Gram-positive coccus is cefazolin; for a Gram-negative rod, gentamicin; and for a filamentous fungi or yeast, natamycin. Broad, antibacterial therapy should be reserved for suspected bacterial keratitis with negative smears or for severe infections with antecedent treatment. Miconazole may be an effective, alternate agent in fungal keratitis. The safety and efficacy of corticosteroids in microbial keratitis have not been established.
（1）做出临床诊断，（2）进行适当的实验室检查，（3）开始抗菌治疗，（4）调整初始治疗方案，（5）终止治疗。这些步骤中最有助于决策的指导原则是：（1）临床印象，（2）角膜炎的严重程度，（3）实验室检查结果，（4）致病微生物的致病潜力，以及（5）各种抗菌药物的有效性和毒性。理想情况下，初始抗生素的选择应根据角膜涂片的解读来指导。由革兰氏阳性球菌引起的角膜炎首选初始抗生素是头孢唑林；由革兰氏阴性杆菌引起的角膜炎首选庆大霉素；由丝状真菌或酵母菌引起的角膜炎首选那他霉素。广谱抗菌治疗应保留用于涂片阴性的疑似细菌性角膜炎或用于先前治疗过的严重感染。咪康唑可能是真菌性角膜炎的一种有效替代药物。皮质类固醇在微生物性角膜炎中的安全性和有效性尚未确定。
