Successful medical therapy of Acanthamoeba keratitis has been reported with combination therapy; topical Brolene and neomycin. Resistance has not so far been identified as a problem, but was the basis for recurrent disease observed in a patient with bilateral infection. Eradication of amoebae was finally achieved following prolonged topical therapy and two corneal grafts in each eye. Topical anti-amoebic therapy with paromomycin, benzethonium chloride, clotrimazole and R11/29 (a phenanthridinium compound), was continued for three months post-operatively. No further recurrences occurred during 14 months' follow-up. Drug sensitivities were performed for three isolates of Acanthamoeba sp (group II) which demonstrated the development of resistance to Brolene and arsenic. In addition, the resistant isolates were temperature-sensitive mutants which would not grow at temperatures above 30°C. This could explain ‘culture-negative’ results in some cases of clinical recurrence when incubation of laboratory samples had only been performed at 37°C.
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Ficker, L., Seal, D., Warhurst, D. et al. Acanthamoeba keratitis—Resistance to medical therapy. Eye 4, 835–838 (1990). https://doi.org/10.1038/eye.1990.132
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