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June 2006

Use of Higher Medication Concentrations in the Treatment of Acanthamoeba Keratitis

Arch Ophthalmol. 2006;124(6):923. doi:10.1001/archopht.124.6.923

Acanthamoeba keratitis is a notoriously difficult therapeutic challenge.1 We have elected to treat the most severe cases by increasing the concentration of a standard topical medication, chlorhexidine, in addition to increasing the frequency of application. Our previous clinical experience comparing a multiple-drug approach to monotherapy with variable concentrations and frequencies suggests that aggressive monotherapy is the most successful strategy. The standard ophthalmic concentration for topical chlorhexidine, or polyhexamethylene biguanine, is 0.02%. By increasing this to either 0.04% or 0.06%, a higher concentration of the drug will be delivered to the tissue and the pathogen. Data from Hay et al,2 Seal,3 and our own experiments suggest that higher drug levels in the tissue should be more effective.4

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