Офтальмохирургия. 2018; : 98-102
Фармакотерапия грибковых кератитов
https://doi.org/10.25276/0235-4160-2018-1-98-102Аннотация
В статье приведен обзор литературы по возможностям применения различных противогрибковых препаратов в лечении грибковых кератитов. Грибковая инфекция глаз представляет собой одну из нерешенных проблем в современной офтальмологии, нередко приводящей не только к слепоте, но и потере глаза как органа. Несмотря на накопленный десятилетиями опыт фармакологического лечения грибковых кератитов, вопрос производства официальных офтальмологических противогрибковых препаратов до сих пор не решен. Офтальмолог, сталкивающийся с такими пациентами, вынужден производить поиск доступных ему средств для оказания помощи. Основываясь на данных литературы, можно сделать заключение, что препаратами первого выбора на сегодня являются натамицин, амфотерицин Б, флюконазол и вориконазол. Однако ни дозировки, ни способы введения данных препаратов до сих пор не стандартизированы. Необходимо учитывать и возможные побочные эффекты при их местном и системном применении. Несмотря на достижения в диагностике и терапевтическом лечении кератомикозов, до 27% пациентам требуются хирургические вмешательства. При этом возможны рецидивы инфекционного процесса. Совершенствование методов диагностики, а также пути введения, концентрации, эффективные комбинации противогрибковых препаратов требуют дальнейшей разработки.
Список литературы
1. Астахов Ю.С., Скрябина Е.В., Коненкова Я.С. и др. Диагностика и лечение грибковых кератитов // Офтальмологические ведомости. – 2013. – Т.VI, № 2. – С. 75-80.
2. Ботабекова Т.К., Кобцева В.Ю., Бердишева А.А. Грибковые поражения роговицы (кератомикозы) (обзор литературы) // Офтальмологический журнал Казахстана. – 2010. – № 2. – С. 64-70. 3. Делягин В.М., Мельникова М.Б., Першин Б.С. и др. Грибковое поражение глаз (диагностика, лечение) // Практическая медицина. – 2015. – Т. 1, № 2-1 (87). – С. 100-105.
3. Майчук Ю.Ф. Фармакотерапия инфекционных заболеваний глаз // Антибиотики и химиотерапия. – 1999. – № 1. – С. 26-30.
4. Новицкая И.В., Сомова В.В. К вопросу выявления микотических инфекций глаз // Успехи медицинской микологии. Т. 14. – М.: Нац. акад. микол., 2015. – С. 156-159.
5. Рациональная фармакотерапия в офтальмологии / Под ред. Е.А. Егорова. 2-е изд., испр. и доп. – М.: Литтерра, 2011. – 1072 с.
6. Abdul Rasool B.K., Salmo H.M. Development and Clinical Evaluation of Clotrimazole–β-Cyclodextrin Eyedrops for the Treatment of Fungal Keratitis // AAPS Pharm. Sci. Tech. – 2012. – Vol. 13, № 3. – P. 883-889.
7. Agarwal P.K., Roy P., Das A. et al. Efficacy of topical and systemic itraconazole as a broadspectrum antifungal agent in mycotic corneal ulcer. A preliminary study // Indian J. Ophthalmol. – 2001. – Vol. 49, № 3. – P. 173-176.
8. Arora R., Gupta D., Goyal J. et al. Voriconazole versus natamycin as primary treatment in fungal corneal ulcers // Clin. Exp. Ophthalmol. – 2011. – Vol. 39, № 5. – P. 434-440.
9. Bachmann S.P., VandeWalle K., Ramage G. et al. In vitro activity of caspofungin against Candida albicans biofilms // Antimicrob. Agents Chemother. – 2002. – Vol. 46, № 11. – P. 3591-3596.
10. Behrens-Baumann W. Mycosis of the eye and its adnexa // Developments in Opthalmology. – Vol. 32. – Basel: S. Karger AG, 1999. – 201 pp.
11. Bhadange Y., Shah B., Takkar B., Sinha R. Review of Doses of Important Drugs in Ophthalmology // Delhi J. Ophthalmol. – 2011. – Vol. 21, № 3. – P. 23-27.
12. Dart J.K., Saw V.P., Kilvington S. Acanthamoeba keratitis: diagnosis and treatment update 2009 // Am. J. Ophthalmol. – 2009. – Vol. 148. – P. 487-499.
13. FlorCruz N.V., Evans J.R. Medical interventions for fungal keratitis // Cochrane Database of Systematic Reviews. – 2015. – Is. 4. – Art. №: CD004241.
14. Ganegoda N., Srinivas K.R. Antifungal therapy for keratomycoses // Expert Opin. Pharmacother. – 2004. – Vol. 5, № 4. – P. 865-874.
15. Goldblum D., Frueh B.E., Sarra G.M. et al. Topical caspofungin for treatment of keratitis caused by Candida albicans in a rabbit model // Antimicrob. Agents Chemother. – 2005. – Vol. 49, № 4. – P. 1359-1363.
16. Guttman C. Diagnostic and therapeutic advances emerging for fungal keratitis // Eurotimes. – 2007. – Vol. 12. – P. 16.
17. Hamill R.J. Amphotericin B formulations: a comparative review of efficacy and toxicity // Drugs. – 2013. – Vol. 73, № 9. – P. 919-934.
18. Hu J., Zhang J., Li Y. et al. A Combination of Intrastromal and Intracameral Injections of Amphotericin B in the Treatment of Severe Fungal Keratitis // J. Ophthalmol. – 2016. – Vol. 2016. – 3436415.
19. Kaur I.P., Rana C., Singh H. Development of effective ocular preparations of antifungal agents // J. Ocul. Pharmacol. Ther. – 2008. – Vol. 24, № 5. – P. 481-493.
20. Mahdy R.A., Nada W.M., Wageh M.M. Assessment safety and efficacy of a combination therapy of topical amphotericin B and subconjunctival fluconazole for the treatment of fungal keratitis // Cutan. Ocul. Toxicol. – 2010. – Vol. 29, № 3. – P. 193-197.
21. Manzouri B., Vafidis G.C., Wyse R. Pharmacotherapy of fungal eye infections // Expert Opin. Pharmacother. – 2001. – Vol. 2, № 11. – P. 1849-1857.
22. Martinez R. Atualização no uso de agentes antifúngicos // J. Bras. Pneumol. – 2006. – Vol. 32, № 5. – P. 449-460.
23. Matsumoto Y., Murat D., Kojima T. et al. The comparison of solitary topical micafungin or fluconazole application in the treatment of Candida fungal keratitis // Br. J. Ophthalmol. – 2010. – Vol. 95, № 10. – P. 1406-1409.
24. Muller G.G., Kara-Jose N., Castro R.S. Antifungals in eye infections: drugs and routes of administration // Rev. Bras. Oftalmol. – 2013. – Vol. 72, № 2. – P. 132-141.
25. Newmark E., Ellison A.C., Kaufman H.E. Combined primaricin and dexamethasone therapy of keratomycosis // Am. J. Ophthalmol. – 1971. – Vol. 71, № 3. – P. 718-722.
26. O’Brien T.P. Therapy of ocular fungal infections // Ophthalmology Clinics of North America. – 1999. – Vol. 12, № 1. – P. 33-50.
27. O’Day D.M. Selection of appropriate antifungal therapy // Cornea. – 1987. – Vol. 6, № 4. – P. 238-245.
28. O’Day D.M., Ray W.A., Head W.S. et al. Influence of corticosteroid on experimentally induced keratomycosis // Arch. Ophthalmol. – 1991. – Vol. 109, № 11. – P. 1601-1604.
29. Pradhan L., Sharma S., Nalamada S. et al. Natamycin in the treatment of keratomycosis: Correlation of treatment outcome and in vitro susceptibility of fungal isolates // Indian J. Ophthalmol. – 2011. – Vol. 59. – P. 512-514.
30. Prajna N.V., John R.K., Nirmalan P.K. et al. A randomised clinical trial comparing 2% econazole and 5% natamycin for the treatment of fungal keratitis // Br. J. Ophthalmol. – 2003. – Vol. 87, № 10. – P. 1235-1237.
31. Prajna N.V., Krishnan T., Mascarenhas J. et al. Mycotic Ulcer Treatment Trial Group. The Mycotic Ulcer Treatment Trial: a randomized trial comparing natamycin vs voriconazole // JAMA Ophthalmol. – 2013. – Vol. 131. – P. 422-429.
32. Qui W., Yao Y., Zhu Y. et al. Fungal spectrum identified by a new slide culture and in vitro drug susceptibility using etest in fungal keratitis // Curr. Eye Res. – 2005. – Vol. 30, № 12. – P. 1113-1120.
33. Rahman M.R., Johnson G.J., Husain R. et al. Randomised trial of 0.2% chlorhexidine gluconate and 2.5% natamycin for fungal keratitis in Bangladesh // Br. J. Ophthalmol. – 1998. – Vol. 82, № 8. – P. 919-925.
34. Sharma N., Chacko J., Velpandian T. et al. Comparative evaluation of topical versus intrastromal voriconazole as an adjunct to natamycin in recalcitrant fungal keratitis // Ophthalmology. – 2013. – Vol. 120, № 4. – P. 677-681.
35. Sharma S., Das S., Virdi A. et al. Re-appraisal of topical 1% voriconazole and 5% natamycin in the treatment of fungal keratitis in a randomised trial // Br. J. Opthalmol. – 2015. – Vol. 99. – P. 1190-1195.
36. Shi W., Wang T., Xie L. et al. Risk factors, clinical features, and outcomes of recurrent fungal keratitis after corneal transplantation // Ophthalmology. – 2010. – Vol. 117. – P. 890-896.
37. Sun C.Q., Lalitha P., Prajna N.V. et al. Mycotic Ulcer Treatment Trial Group. Association Between In Vitro Susceptibility to Natamycin and Voriconazole and Clinical Outcomes in Fungal Keratitis // Ophthalmology. – 2014. – Vol. 121, № 8. – P. 1495-1500.
38. Thomas P.A. Fungal infections of cornea // Eye. – 2003. – Vol. 17, № 8. – P. 852-862.
39. Thomas P.A. Current perspectives on ophthalmic mycoses // Clin. Microbiol. Rev. – 2003. – Vol. 16, № 4. – P. 730-797.
40. Thomas P.A., Geraldine P. Adjunctive topical versus intrastromal voriconazole in mycotic keratitis // Expert Rev. Ophthalmol. – 2013. – Vol. 8, № 5. – P. 413-415.
41. Tsai S.H., Lin Y.C., Hsu H.C., Chen Y.M. Subconjunctival Injection of Fluconazole in the Treatment of Fungal Alternaria Keratitis // Ocul. Immunol. Inflamm. – 2016. – Vol. 24, № 1. – P. 103-106.
42. Vemuganti G.K., Garg P., Gopinathan U. et al. Evaluation of agent and host factors in progression of mycotic keratitis: A histologic and microbiologic study of 167 corneal buttons // Ophthalmology. – 2002. – Vol. 109. – P. 1538-1546.
43. Wagner C., Graninger W., Presterl E., Joukhadar C. The echinocandins: comparison of their pharmacokinetics, pharmacodynamics and clinical applications // Pharmacology. – 2006. – Vol. 78, № 4. – P. 161-177.
Fyodorov Journal of Ophthalmic Surgery. 2018; : 98-102
Pharmacotherapy of Fungal Keratitis
https://doi.org/10.25276/0235-4160-2018-1-98-102Abstract
The article presents a review of the literature on the various possibilities in application of antifungal drugs in the treatment of fungal keratitis. The fungal infection of the eye is one of the problems unsolved in the modern ophthalmology, which often leads not only to blindness, but to the loss of the eye as an organ. Despite decades of experience in the pharmacological treatment of fungal keratitis, the question of the officinal production of ophthalmic antifungal drugs has not yet been resolved. An ophthalmologist who has such patients is forced to search for resources available to him to provide medical care. As can be inferred from the literature, nowadays the drugs of first choice are natamycin, amphotericin B, fluconazole, and voriconazole. However, neither dosing nor modes of administration of these drugs are still standardized. It is also necessary to take into account possible side effects in their local and systemic application. Despite advances in the diagnosis and therapeutic treatment of mycotic keratitis, up to 27% of patients still require surgical interventions. But postoperative recurrences of the infection process can occur. More research (and closer attention from pharmaceutical companies) is needed to further investigate the routes of administration, concentrations and effective combinations of antifungal drugs as well as the improvement of the methods of diagnosing fungal infection.
References
1. Astakhov Yu.S., Skryabina E.V., Konenkova Ya.S. i dr. Diagnostika i lechenie gribkovykh keratitov // Oftal'mologicheskie vedomosti. – 2013. – T.VI, № 2. – S. 75-80.
2. Botabekova T.K., Kobtseva V.Yu., Berdisheva A.A. Gribkovye porazheniya rogovitsy (keratomikozy) (obzor literatury) // Oftal'mologicheskii zhurnal Kazakhstana. – 2010. – № 2. – S. 64-70. 3. Delyagin V.M., Mel'nikova M.B., Pershin B.S. i dr. Gribkovoe porazhenie glaz (diagnostika, lechenie) // Prakticheskaya meditsina. – 2015. – T. 1, № 2-1 (87). – S. 100-105.
3. Maichuk Yu.F. Farmakoterapiya infektsionnykh zabolevanii glaz // Antibiotiki i khimioterapiya. – 1999. – № 1. – S. 26-30.
4. Novitskaya I.V., Somova V.V. K voprosu vyyavleniya mikoticheskikh infektsii glaz // Uspekhi meditsinskoi mikologii. T. 14. – M.: Nats. akad. mikol., 2015. – S. 156-159.
5. Ratsional'naya farmakoterapiya v oftal'mologii / Pod red. E.A. Egorova. 2-e izd., ispr. i dop. – M.: Litterra, 2011. – 1072 s.
6. Abdul Rasool B.K., Salmo H.M. Development and Clinical Evaluation of Clotrimazole–β-Cyclodextrin Eyedrops for the Treatment of Fungal Keratitis // AAPS Pharm. Sci. Tech. – 2012. – Vol. 13, № 3. – P. 883-889.
7. Agarwal P.K., Roy P., Das A. et al. Efficacy of topical and systemic itraconazole as a broadspectrum antifungal agent in mycotic corneal ulcer. A preliminary study // Indian J. Ophthalmol. – 2001. – Vol. 49, № 3. – P. 173-176.
8. Arora R., Gupta D., Goyal J. et al. Voriconazole versus natamycin as primary treatment in fungal corneal ulcers // Clin. Exp. Ophthalmol. – 2011. – Vol. 39, № 5. – P. 434-440.
9. Bachmann S.P., VandeWalle K., Ramage G. et al. In vitro activity of caspofungin against Candida albicans biofilms // Antimicrob. Agents Chemother. – 2002. – Vol. 46, № 11. – P. 3591-3596.
10. Behrens-Baumann W. Mycosis of the eye and its adnexa // Developments in Opthalmology. – Vol. 32. – Basel: S. Karger AG, 1999. – 201 pp.
11. Bhadange Y., Shah B., Takkar B., Sinha R. Review of Doses of Important Drugs in Ophthalmology // Delhi J. Ophthalmol. – 2011. – Vol. 21, № 3. – P. 23-27.
12. Dart J.K., Saw V.P., Kilvington S. Acanthamoeba keratitis: diagnosis and treatment update 2009 // Am. J. Ophthalmol. – 2009. – Vol. 148. – P. 487-499.
13. FlorCruz N.V., Evans J.R. Medical interventions for fungal keratitis // Cochrane Database of Systematic Reviews. – 2015. – Is. 4. – Art. №: CD004241.
14. Ganegoda N., Srinivas K.R. Antifungal therapy for keratomycoses // Expert Opin. Pharmacother. – 2004. – Vol. 5, № 4. – P. 865-874.
15. Goldblum D., Frueh B.E., Sarra G.M. et al. Topical caspofungin for treatment of keratitis caused by Candida albicans in a rabbit model // Antimicrob. Agents Chemother. – 2005. – Vol. 49, № 4. – P. 1359-1363.
16. Guttman C. Diagnostic and therapeutic advances emerging for fungal keratitis // Eurotimes. – 2007. – Vol. 12. – P. 16.
17. Hamill R.J. Amphotericin B formulations: a comparative review of efficacy and toxicity // Drugs. – 2013. – Vol. 73, № 9. – P. 919-934.
18. Hu J., Zhang J., Li Y. et al. A Combination of Intrastromal and Intracameral Injections of Amphotericin B in the Treatment of Severe Fungal Keratitis // J. Ophthalmol. – 2016. – Vol. 2016. – 3436415.
19. Kaur I.P., Rana C., Singh H. Development of effective ocular preparations of antifungal agents // J. Ocul. Pharmacol. Ther. – 2008. – Vol. 24, № 5. – P. 481-493.
20. Mahdy R.A., Nada W.M., Wageh M.M. Assessment safety and efficacy of a combination therapy of topical amphotericin B and subconjunctival fluconazole for the treatment of fungal keratitis // Cutan. Ocul. Toxicol. – 2010. – Vol. 29, № 3. – P. 193-197.
21. Manzouri B., Vafidis G.C., Wyse R. Pharmacotherapy of fungal eye infections // Expert Opin. Pharmacother. – 2001. – Vol. 2, № 11. – P. 1849-1857.
22. Martinez R. Atualização no uso de agentes antifúngicos // J. Bras. Pneumol. – 2006. – Vol. 32, № 5. – P. 449-460.
23. Matsumoto Y., Murat D., Kojima T. et al. The comparison of solitary topical micafungin or fluconazole application in the treatment of Candida fungal keratitis // Br. J. Ophthalmol. – 2010. – Vol. 95, № 10. – P. 1406-1409.
24. Muller G.G., Kara-Jose N., Castro R.S. Antifungals in eye infections: drugs and routes of administration // Rev. Bras. Oftalmol. – 2013. – Vol. 72, № 2. – P. 132-141.
25. Newmark E., Ellison A.C., Kaufman H.E. Combined primaricin and dexamethasone therapy of keratomycosis // Am. J. Ophthalmol. – 1971. – Vol. 71, № 3. – P. 718-722.
26. O’Brien T.P. Therapy of ocular fungal infections // Ophthalmology Clinics of North America. – 1999. – Vol. 12, № 1. – P. 33-50.
27. O’Day D.M. Selection of appropriate antifungal therapy // Cornea. – 1987. – Vol. 6, № 4. – P. 238-245.
28. O’Day D.M., Ray W.A., Head W.S. et al. Influence of corticosteroid on experimentally induced keratomycosis // Arch. Ophthalmol. – 1991. – Vol. 109, № 11. – P. 1601-1604.
29. Pradhan L., Sharma S., Nalamada S. et al. Natamycin in the treatment of keratomycosis: Correlation of treatment outcome and in vitro susceptibility of fungal isolates // Indian J. Ophthalmol. – 2011. – Vol. 59. – P. 512-514.
30. Prajna N.V., John R.K., Nirmalan P.K. et al. A randomised clinical trial comparing 2% econazole and 5% natamycin for the treatment of fungal keratitis // Br. J. Ophthalmol. – 2003. – Vol. 87, № 10. – P. 1235-1237.
31. Prajna N.V., Krishnan T., Mascarenhas J. et al. Mycotic Ulcer Treatment Trial Group. The Mycotic Ulcer Treatment Trial: a randomized trial comparing natamycin vs voriconazole // JAMA Ophthalmol. – 2013. – Vol. 131. – P. 422-429.
32. Qui W., Yao Y., Zhu Y. et al. Fungal spectrum identified by a new slide culture and in vitro drug susceptibility using etest in fungal keratitis // Curr. Eye Res. – 2005. – Vol. 30, № 12. – P. 1113-1120.
33. Rahman M.R., Johnson G.J., Husain R. et al. Randomised trial of 0.2% chlorhexidine gluconate and 2.5% natamycin for fungal keratitis in Bangladesh // Br. J. Ophthalmol. – 1998. – Vol. 82, № 8. – P. 919-925.
34. Sharma N., Chacko J., Velpandian T. et al. Comparative evaluation of topical versus intrastromal voriconazole as an adjunct to natamycin in recalcitrant fungal keratitis // Ophthalmology. – 2013. – Vol. 120, № 4. – P. 677-681.
35. Sharma S., Das S., Virdi A. et al. Re-appraisal of topical 1% voriconazole and 5% natamycin in the treatment of fungal keratitis in a randomised trial // Br. J. Opthalmol. – 2015. – Vol. 99. – P. 1190-1195.
36. Shi W., Wang T., Xie L. et al. Risk factors, clinical features, and outcomes of recurrent fungal keratitis after corneal transplantation // Ophthalmology. – 2010. – Vol. 117. – P. 890-896.
37. Sun C.Q., Lalitha P., Prajna N.V. et al. Mycotic Ulcer Treatment Trial Group. Association Between In Vitro Susceptibility to Natamycin and Voriconazole and Clinical Outcomes in Fungal Keratitis // Ophthalmology. – 2014. – Vol. 121, № 8. – P. 1495-1500.
38. Thomas P.A. Fungal infections of cornea // Eye. – 2003. – Vol. 17, № 8. – P. 852-862.
39. Thomas P.A. Current perspectives on ophthalmic mycoses // Clin. Microbiol. Rev. – 2003. – Vol. 16, № 4. – P. 730-797.
40. Thomas P.A., Geraldine P. Adjunctive topical versus intrastromal voriconazole in mycotic keratitis // Expert Rev. Ophthalmol. – 2013. – Vol. 8, № 5. – P. 413-415.
41. Tsai S.H., Lin Y.C., Hsu H.C., Chen Y.M. Subconjunctival Injection of Fluconazole in the Treatment of Fungal Alternaria Keratitis // Ocul. Immunol. Inflamm. – 2016. – Vol. 24, № 1. – P. 103-106.
42. Vemuganti G.K., Garg P., Gopinathan U. et al. Evaluation of agent and host factors in progression of mycotic keratitis: A histologic and microbiologic study of 167 corneal buttons // Ophthalmology. – 2002. – Vol. 109. – P. 1538-1546.
43. Wagner C., Graninger W., Presterl E., Joukhadar C. The echinocandins: comparison of their pharmacokinetics, pharmacodynamics and clinical applications // Pharmacology. – 2006. – Vol. 78, № 4. – P. 161-177.
