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September 1998

Routine Antibiotic Sensitivity Testing for Corneal Ulcers—Reply

Arch Ophthalmol. 1998;116(9):1262-1263. doi:

In reply

I appreciate the comments made by Messrs Morlet and Dart regarding our publication1 on the use of routine antibiotic sensitivity testing for the management of corneal ulcers. I agree that delayed healing may be due to factors other than persistent infection. Our point in this article was that the antibiotic sensitivities did not help us in the management of this small series of patients with culture-positive corneal ulcers. In our series, patients were initially treated with fortified antibiotics, aminoglycocide and cefazolin. Vancomycin was only given to patients who were allergic to penicillin or who had resistant infections. We agree that initial therapy of small corneal ulcers without obtaining a culture is appropriate in the primary care setting and that patients who do not respond promptly to treatment should be referred for subspecialty care. It is our practice in these circumstances to routinely obtain cultures and sensitivity information. It was of interest to us, however, that the sensitivity data did not help us in the management of these infections. We agree that there is a need for better methods of sensitivity testing of antibiotics used to treat eye infections based on corneal drug levels. The microbiology laboratory at Wills Eye Hospital predominantly uses ocular isolates for treatment. The laboratory recognizes that organisms that are often considered nonpathogenic can be pathogenic in the cornea. Since 1994, when patients in this article were treated, our approach in the microbiology laboratory has been to limit the types of antibiotics that are tested for specific isolates. We agree that on an epidemiological level it is very important to gather information regarding organisms and sensitivities so that one can follow local patterns of resistance. We also agree that local data are necessary for the appropriate use of optimal initial empirical therapy of corneal ulcers.