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    JAMAJAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Facial Plastic Surgery JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Hariprasad SMMieler WFHolz ER et al. Determination of vitreous, aqueous, and plasma concentration of orally administered voriconazole in humans. Arch Ophthalmol 2004;122 (1) 42- 47Pub Med Google Scholar Crossref Espinel-Ingroff A In vitro fungicidal activities of voriconazole, itraconazole, and amphotericin B against opportunistic moniliaceous and dematiaceous fungi. J Clin Microbiol 2001;39 (3) 954- 958Pub Med Google Scholar Crossref Sanati HBelanger RFFratti RGhannoum M A new triazole, voriconazole (UK-109,496), blocks sterol biosynthesis in Candida albicans and Candida krusei. Antimicrob Agents Chemother 1997;41 (11) 2492- 2496Pub Med Google Scholar Klont RREggink CARijs AJWesseling PVerweij PE Successful treatment of Fusarium keratitis with cornea transplantation and topical and systemic voriconazole. Accessed December 13, 2007Google Scholar Crossref Hernández Prats CLlinares Tello FBurgos San José ASelva Otaolaurruchi JOrdovás Baines JP Voriconazole in fungal keratitis caused by Scedosporium apiospermum. Ann Pharmacother 2004;38 (3) 414- 417Pub Med Google Scholar Crossref Gao HPennesi MEShah K et al. Intravitreal voriconazole: an electroretinographic and histopathologic study [published correction appears in Arch Ophthalmol. levitra original Correspondence Address: Eman F Mottawea Department of Shebin El Kom Ophthalmology Hospital, Menoufia University, Ahmed Abu Sena Street, Shebin El Kom, Menoufia, 32511 Egypt Source of Support: None, Conflict of Interest: None Objectives The aim of this study was to compare the use of topical amphotericin B (0.5 mg/ml) eye drops with the use of subconjunctival injection of fluconazole (2 mg/ml) in dealing with cases of fungal keratitis. Background Fungal keratitis is considered one of the serious ocular infections that lead to ocular morbidity and visual loss, especially in developing countries. Materials and methods This study was carried out on 50 eyes of 50 patients with resistant corneal ulcers attending Menoufia University Hospital outpatient clinic between July 2012 and February 2014. Results Group 1 included 25 cases treated with topical amphotericin B; the study revealed healing of corneal ulcers in six cases (24%), and 19 cases (76%) developed complications. Group 2 included 25 cases treated with subconjunctival fluconazole injection; the study revealed statistically significant result (P How to cite this article: El-Sayed SH, Wagdy FM, El-Hagaa AA, Mottawea EF. Topical amphotericin B versus subconjunctival fluconazole injection in the management of fungal keratitis. Menoufia Med J 2016;1-5How to cite this URL: El-Sayed SH, Wagdy FM, El-Hagaa AA, Mottawea EF.

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    Treatment of fungal eye infections represents a challenge to the ophthalmology practice. Topical caspofungin for treatment of keratitis caused by Candida albicans in a rabbit model. For an adequate therapeutic response, besides correct drug choice, it is necessary an effectively administration. This script gathers information about the major antifungal drugs used in eye infections, their concentrations and main administration routes., an increasing number of cases has been observed. The echinocandins: comparison of their pharmacokinetics, pharmacodynamics and clinical applications. Factors such as corticosteroid use, which facilitates the penetration of pathogens, and the popularisation of topical antibiotics, which create an environment of lower competition among microorganisms on the ocular surface, as suggested as key factors for such increase. Despite the emergence of new drugs, cure remains difficult in many cases. Bachmann SP, Vande Walle K, Ramage G, Patterson TF, Wickes BL, Graybill JR, López-Ribot JL. Compared to antibacterials, antifungals have a lower efficacy due to their mechanism of action (usually fungistatic, with fungicidal action being dose dependent), lower tissue penetration, and the indolent nature of the infection This paper aims to present information on the main antifungals currently used for the treatment of fungal keratitis and endophthalmitis, highlighting their advantages and disadvantages in order to facilitate the choice of the most appropriate therapy for each case. In vitro activity of caspofungin against Candida albicans biofilms. This class of antifungal agents includes amphotericin B (AMB), nystatin and natamycin (NTM). Flucytosine: a review of its pharmacology, clinical indications, pharmacokinetics, toxicity and drug interactions. Fluconazole is a first-generation triazole antifungal medication. It differs from earlier azole antifungals (such as ketoconazole) in that its structure contains a triazole ring instead of an imidazole ring. While the imidazole antifungals are mainly used topically, fluconazole and certain other triazole antifungals are preferred when systemic treatment is required because of their improved safety and predictable absorption when administered orally. Fluconazole's spectrum of activity includes most Candida species (but not Candida krusei or Candida glabrata), Cryptococcus neoformans, some dimorphic fungi, and dermatophytes, among others. Common uses include: Fungal resistance to drugs in the azole class tends to occur gradually over the course of prolonged drug therapy, resulting in clinical failure in immunocompromised patients (e.g., patients with advanced HIV receiving treatment for thrush or esophageal Candida infection). albicans, resistance occurs by way of mutations in the ERG11 gene, which codes for 14α-demethylase. These mutations prevent the azole drug from binding, while still allowing binding of the enzyme's natural substrate, lanosterol. glabrata is increasing the rate of efflux of the azole drug from the cell, by both ATP-binding cassette and major facilitator superfamily transporters. Development of resistance to one azole in this way will confer resistance to all drugs in the class. Other gene mutations are also known to contribute to development of resistance.

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