This protocol covers the specific situation of bacterial suppurative keratitis — corneal ulcer with no fungal hyphae seen on corneal smear — where the ulcer has not responded to the first-line antibiotic regimen within the expected timeframe.
Suppurative keratitis (corneal ulcer) in which the corneal smear shows no fungal hyphae, pointing to a non-fungal, most likely bacterial, cause. Despite an initial antibiotic course, the ulcer has not shown the expected improvement on daily examination by 3 days of treatment.
First-line therapy with Cefazolin and Gentamycin eye drops hourly — or Ciprofloxacin as an alternative — did not achieve the goal of a visibly improving ulcer on daily examination within 3 days. This protocol defines the structured approach taken after that failure.
Management focuses on identifying the reason for therapeutic failure. This begins with a reassessment using available microbiological results, and — depending on the findings — may require collecting new specimens before any further treatment decisions are made. Adjustments to antibiotic coverage and to how treatment is delivered are central to this step. The full structured protocol with all criteria and options is available via the link below.