Rahman M R, Johnson G J, Husain R, Howlader S A, Minassian D C
Department of Preventive Ophthalmology, University College London.
Br J Ophthalmol. 1998 Aug;82(8):919-25. doi: 10.1136/bjo.82.8.919.
The management of suppurative keratitis due to filamentous fungi presents severe problems in tropical countries. The aim was to demonstrate the efficacy of chlorhexidine 0.2% drops as an inexpensive antimicrobial agent, which could be widely distributed for fungal keratitis.
Successive patients presenting to the Chittagong Eye Institute and Training Complex with corneal ulcers were admitted to the trial when fungal hyphae had been seen on microscopy. They were randomised to drop treatment with chlorhexidine gluconate 0.2% or the standard local treatment natamycin 2.5%. The diameters, depths, and other features of the ulcers were measured and photographed at regular intervals. The outcome measures were healing at 21 days and presence or absence of toxicity. If there was not a favourable response at 5 days, "treatment failure" was recorded and the treatment was changed to one or more of three options, which included econazole 1% in the latter part of the trial.
71 patients were recruited to the trial, of which 35 were randomised to chlorhexidine and 36 to natamycin. One allocated to natamycin grew bacteria and therefore was excluded from the analysis. None of the severe ulcers was fully healed at 21 days of treatment, but three of those allocated to chlorhexidine eventually healed in times up to 60 days. Of the nonsevere ulcers, 66.7% were healed at 21 days with chlorhexidine and 36.0% with natamycin, a relative efficacy (RE) of 1.85 (CL 1.01-3.39, p = 0.04). If those ulcers were excluded where fungi were seen in the scraping but did not grow on culture, the estimated efficacy ratio does not change but becomes less precise because of smaller numbers. Equal numbers of Aspergillus (22) and Fusarium (22) were grown. The Aspergillus were the most resistant to either primary treatment.
Chlorhexidine may have potential as an inexpensive topical agent for fungal keratitis and warrants further assessment as a first line treatment in situations where microbiological facilities and a range of antifungal agents are not available.
在热带国家，丝状真菌性化脓性角膜炎的治疗存在严重问题。本研究旨在证明0.2%洗必泰滴眼液作为一种廉价抗菌药物的疗效，该药物可广泛用于治疗真菌性角膜炎。
连续有角膜溃疡的患者到吉大港眼科研究所及培训中心就诊，显微镜下发现真菌菌丝后纳入试验。他们被随机分为接受0.2%葡萄糖酸氯己定滴眼液治疗组或标准局部治疗的2.5%那他霉素组。定期测量并拍摄溃疡的直径、深度及其他特征。观察指标为21天时溃疡愈合情况及有无毒性。若5天时无良好反应，则记录为“治疗失败”，并将治疗改为三种选择中的一种或多种，试验后期的选择包括1%益康唑。
71例患者纳入试验，其中35例随机接受洗必泰治疗，36例接受那他霉素治疗。1例分配至那他霉素组的患者培养出细菌，因此被排除在分析之外。治疗21天时，所有重度溃疡均未完全愈合，但分配至洗必泰组的3例患者最终在60天内愈合。在非重度溃疡中，洗必泰组21天时66.7%愈合，那他霉素组为36.0%，相对疗效（RE）为1.85（可信区间1.01 - 3.39，p = 0.04）。若排除刮片中发现真菌但培养未生长的溃疡，估计疗效比值不变，但由于样本量较小，精确性降低。培养出的曲霉菌（22株）和镰刀菌（22株）数量相等。曲霉菌对两种初始治疗的耐药性最强。
洗必泰可能作为一种廉价的局部用药治疗真菌性角膜炎，在缺乏微生物检测设施和多种抗真菌药物的情况下，作为一线治疗值得进一步评估。
