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Netilmicine as a treatment for Acanthamoeba keratitis : three cases

Netilmicine as a treatment for Acanthamoeba keratitis : three cases . O regon M. Eric Y, Vanzzini Z. Virginia, Sierra A. Antonio, Zand H. Igal M, Moreno A. Gilberto, Naranjo T. Ramón Cornea & Refractive Surgery department , Asociación para evitar la ceguera en México A.P.E.C.

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Netilmicine as a treatment for Acanthamoeba keratitis : three cases

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  1. Netilmicine as a treatment for Acanthamoebakeratitis: three cases Oregon M. Eric Y, Vanzzini Z. Virginia, Sierra A. Antonio, Zand H. Igal M, Moreno A. Gilberto, Naranjo T. Ramón Cornea & RefractiveSurgerydepartment , Asociación para evitar la ceguera en México A.P.E.C. Universidad Nacional Autónoma de México U.N.A.M. Thefirstauthor of this poster receivedtravel expense reimbursementby SIFI laboratories México. Off label use of topicalnetilmicineforAcanthamoebakeratitis.

  2. Introduction The standard treatment for Acanthamoeba keratitis includes clorhexidine and/or propamidine Isethionate and aminoglucosides such as Neomicyn. Together with oral Itraconazole and topical antifungals. However none of this treatments have proven total efficiency and Acanthamoeba keratitis is still a serious corneal disease. • John Thomas, Lin J, Sahm DF. Ann Ophthalmol 1990; 22:20-23 • Ishibashi Y, Matsumoto J, Katata T et al. Am Jour Ophthalmol 1990; 109: (2) 121-126 • Bang S, Edell E, Eghrari AO, Gottsch JD. Treatment with voriconazole in 3 eyes with resistant Acanthamoeba keratitis. Am J Ophthalmol. 2010 Jan;149(1):66-9. Epub 2009 Oct 28

  3. Purpose Toreport 3 cases of Acanthamoebakeratitissuccesfullytreatedwith a combination of topicalNetilmicine(Netira- SIFI Lab. SicillyItaly) , Polimixin, Neomycin and Gramicidin( Polixin- GrinMexicocity) with oral Itraconazole(Isox -SenosiainMexico). Pre- treatment End of follow up

  4. Material & Methods • Corneal samples were taken and cultured in NN agar with a lived Enterobacter cloacae layer. • The cultures were positive for Acanthamoeba castellani. • Photographs were taken on their 1st visit and 3 months final follow up. • Susceptibility by dilution method to Netilmicine (Netromycin) was done.

  5. Case 1. Leftimage: notesstheperineuralinfiltrate in a radial dispositionthatstarts in the center of the cornea. Rightimage: theinfiltrateondetail, notessalsotheconjunctivalhyperemia.

  6. Case 2: Up in theleft: look at the ring infiltrateonthe center of the cornea. Left: fluoresceindiffusestaining Up ontheright.- notessthefaint ring at theend of follow up.

  7. Rightimage: Cystsonconfocalmicroscopy at the anterior stroma. Leftimage: Trophozoitesonthe culture Cinetics of theeffect of netromycin 100mg/ml- (netilmicinebrand of systemicpresentation in México & US) onthegrowing of threeAcanthamoebacolonies. Specialthanksto Dr. Marco Rodríguez PhD Y= Number of amoebasX=Hours. Notessthedifferencewiththe control (in black).

  8. Discussion Webelievethattheearly diagnosis of Acanthamoebakeratitisis crucial forthe prognosis of thediseasein our cases and otherreportedontheliterature. NetilmicinewasamoebostaticforAcanthamoebacastellani as showedonthegraphic; wehave no knowledge of anyotherreport of this fact. No surgicalinterventionwasneeded in any case, no sideeffectswerefoundonanypatient.

  9. Conclusions A combinedtreatment of antifungal (oral itraconazole) and theaminoglucosideNetilmicine, seemsto be a greatoptionforthequick and sustainedimprovement of ourpatients. oregonmir@live.com.mx

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