Bacterial Keratitis Not Responding to Initial Fluoroquinolone Therapy
Clinical Scenario
This protocol addresses bacterial keratitis that fails to show the expected improvement or stabilisation after first-line single-agent topical fluoroquinolone treatment — a pattern that signals the need for a more intensive antibiotic strategy.
When the Previous Treatment Did Not Work
Standard first-line care — topical fluoroquinolone monotherapy (ciprofloxacin, ofloxacin, or levofloxacin), with or without cycloplegic agents — targets clear clinical improvement within 48 hours: reduced pain and discharge, consolidation and sharper demarcation of the stromal infiltrate, decreased infiltrate density, reduced anterior chamber cells or hypopyon, initial re-epithelialisation, and cessation of progressive corneal thinning. When these signs are absent, or the keratitis continues to progress, escalation to the next treatment line is indicated.
Next-Step Approach (Partial)
For eyes unresponsive to initial fluoroquinolone therapy — especially those with large or visually significant corneal infiltrates or a hypopyon — combination fortified-antibiotic therapy is among the strategies considered. The complete regimen, specific indications, and clinical sequencing are available in the full structured protocol.
References
- Fortified topical antibiotics should be considered for large and/or visually significant corneal infiltrates, especially if a hypopyon is present.
- Combination fortified-antibiotic therapy is an alternative to consider, especially for severe infection and for eyes unresponsive to initial treatment.
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