Hay J, Kirkness C M, Seal D V, Wright P
Department of Bacteriology, Royal Infirmary, Glasgow, UK.
Eye (Lond). 1994;8 ( Pt 5):555-63. doi: 10.1038/eye.1994.137.
Trophozoites and cysts of 20 isolates of Acanthamoeba from the cornea and five from related samples were tested in vitro for sensitivity to ten drugs (three aromatic diamidines, two aminoglycosides, two macrolides, a polyene macrolide antibiotic, an organoarsenical and an antimetabolite) and two cationic antiseptics (chlorhexidine and polyhexamethylene biguanide, PHMB). Only chlorhexidine and PHMB showed uniform amoebacidal activity. Aromatic diamidines (pentamidine isethionate, propamidine isethionate and diminazene aceturate) generally proved effective against both forms of the amoeba; only pentamidine gave synergy with the biguanide while propamidine gave an additive effect. Other drugs tested proved erratic or ineffective against different isolates. Chlorhexidine alone, or together with propamidine, was subsequently used in two patients with proven Acanthamoeba keratitis; the causative isolates were sensitive to the individual compounds and to the combination in vitro. The treatment provided resolution of the clinical disease; amoebae were shown to be nonviable by histology and culture. The combination of chlorhexidine and propamidine is recommended for treatment of proven Acanthamoeba keratitis.
对从角膜分离出的20株棘阿米巴原虫的滋养体和包囊以及从相关样本中分离出的5株进行体外测试，检测它们对10种药物（三种芳香族双脒、两种氨基糖苷类、两种大环内酯类、一种多烯大环内酯抗生素、一种有机砷化合物和一种抗代谢物）和两种阳离子防腐剂（洗必泰和聚六亚甲基双胍，PHMB）的敏感性。只有洗必泰和PHMB表现出一致的杀阿米巴活性。芳香族双脒（乙磺半胱氨酸戊烷脒、乙磺半胱氨酸丙脒和乙酰甘氨酸二脒那嗪）通常对两种阿米巴原虫形式都有效；只有戊烷脒与双胍有协同作用，而丙脒有相加作用。测试的其他药物对不同分离株的效果不稳定或无效。洗必泰单独使用或与丙脒联合使用，随后用于两名确诊为棘阿米巴角膜炎的患者；致病分离株在体外对单一化合物和联合用药均敏感。治疗使临床疾病得到缓解；组织学和培养显示阿米巴原虫无活力。推荐洗必泰和丙脒联合用于治疗确诊的棘阿米巴角膜炎。
