Oral amoxicillin-clavulanate: an alternative treatment to refractory Nocardia keratitis-a case report
Abstract
Background: Bacterial keratitis (bacterial corneal infection) is a serious, vision-threatening disease caused by a wide range of bacterial species. The gram-positive bacterium Nocardia spp. is increasingly recognized in keratitis, yet is particularly challenging to treat due to delayed diagnosis and limited efficacy of current ophthalmic therapeutics. Antimicrobial resistance among clinical Nocardia isolates is also rising, further complicating patient outcomes. Herein, we report a case of Nocardia amikacinitolerans keratitis, resistant to amikacin, ciprofloxacin, moxifloxacin, clarithromycin, and ceftriaxone, resulting in a complicated therapeutic course.
Case summary: A 53-year-old female presented with bacterial keratitis of the right eye, which over the course of 32 months progressed to scleritis (infection of the sclera) and a progressive, significant decrease in visual acuity to hand motion despite exhaustive topical and systemic antimicrobial therapies. While there is a general lack of efficacy of systemic therapies for bacterial keratitis, oral amoxicillin-clavulanate ultimately proved successful in resolving the infection.
Conclusion: As Nocardia spp. ocular infections become more prevalent, this report underscores the highly virulent nature of this pathogen and provides insights into potential therapeutic modalities in the setting of multidrug resistance.
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Synthesis, In Vitro and In Silico Molecular Docking Studies of Novel Phthalimide–Pyrimidine Hybrid Analogues to Thalidomide as Potent Antitubercular Agents
- Exploring the inhibitory performance of expired moxifloxacin and norfloxacin on copper corrosion in saline environment
- Molecular investigation of antimicrobial peptides against Helicobacter pylori proteins using a peptide-protein docking approach
- Screening of novel narrow-spectrum benzofuroxan derivatives for the treatment of multidrug-resistant tuberculosis through in silico, in vitro, and in vivo approaches
- Synthesis, Characterization, Anticancer, Antioxidant, and In Silico Evaluation of Semicarbazides and Thiosemicarbazides
- Fast and accurate prediction of drug induced proarrhythmic risk with sex specific cardiac emulators
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.