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Use of Topical Colistin in Multiple Drug-Resistant Pseudomonas aeruginosa Bacterial Keratitis

Jain, Rajat MS; Murthy, Somasheila I. MS; Motukupally, Swapna R. MD; Jain, Mitesh MS

doi: 10.1097/ICO.0000000000000184
Clinical Science

Purpose: The aim of this study was to report the utility of topical colistin in multi–drug resistant Pseudomonas aeruginosa bacterial keratitis.

Methods: Retrospective interventional case series included 8 patients with culture-proven multi–drug resistant P. aeruginosa (MDR-PA) bacterial keratitis who presented from June 2011 to January 2012 and were treated with colistin 0.19% as monodrug therapy. Clinical/microbiological data were collected from medical records. All patients underwent microbiological corneal scraping. Intensive half-hourly therapy with broad-spectrum antibiotics was changed to colistin 0.19% when antibiotic sensitivity reports were available. The outcome was a “complete success” if resolution of infection occurred with scar formation without any subsequent recurrence up to 2 weeks and “partial success” if it also required a cyanacrylate glue application. The outcome was a “failure” if the patient required a therapeutic graft or if the infection could not be controlled and the eye needed evisceration.

Results: The mean age was 45 ± 16 years; the M:F ratio was 1:1. Seven patients had a history of ocular surgery. The mean size of the infiltrate was 15.41 ± 22.2 mm2 and was full thickness in 5 patients. Success was achieved in 7 out of 8 patients, and the infiltrate gradually decreased with resolution of infection in a mean duration of 30.5 ± 16 days. Complete and partial success were noted in 4 and 3 patients, respectively. The final visual acuity was 20/60 or better in 4 patients. One patient required a sclerocorneal patch graft. No complications of topical colistin were noticed.

Conclusions: The early use of topical colistin 0.19% was found to be a safe and effective alternative in the management of multi–drug resistant P. aeruginosa bacterial keratitis.

*Cornea and Anterior Segment Services, L V Prasad Eye Institute, Bhubaneswar, India;

Cornea and Anterior Segment Services; and

Jhaveri Ocular Microbiology Services, L V Prasad Eye Institute, Hyderabad, India.

Reprints: Rajat Jain, MS, Cornea and Anterior Segment Services, L V Prasad Eye Institute, Patia, Bhubaneswar, Odisha 751024, India (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received November 09, 2013

Accepted May 11, 2014

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