In vitro susceptibility of bacterial keratitis isolates to fourth-generation fluoroquinolones

Eur J Ophthalmol. 2010 Mar-Apr;20(2):300-5. doi: 10.1177/112067211002000207.


Purpose: To study the microbiological profile of bacterial keratitis in Northern India and to determine the antibiotic sensitivity pattern of bacterial keratitis isolates to fourth-generation fluoroquinolones.

Methods: Laboratory records of all consecutive cases of clinically suspected bacterial corneal ulcers were retrospectively reviewed. Data noted included microorganism isolated and antibiotic culture sensitivity to cefazolin, tobramycin, gatifloxacin, and moxifloxacin. In vitro susceptibility toward individual antibiotics was determined and compared with the potential in vitro susceptibilities to cefazolin-tobramycin, cefazolin-gatifloxacin, and cefazolin-moxifloxacin combinations.

Results: A total of 292 bacterial isolates were identified. Of these, 255 (87.3%) were Gram-positive and 37 (12.7%) were Gram-negative. Staphylococcus epidermidis (n=227, 77.7%) was the most common organism. Overall susceptibility of isolates was 95.52% to gatifloxacin, 92.83% to moxifloxacin, 90.07% to tobramycin, and 83.56% to cefazolin (p<0.000). Organisms which showed resistance to fourth-generation fluoroquinolones included Staphylococcus epidermidis, Pseudomonas aeruginosa, viridans streptococci, Streptococcus pneumoniae, Staphylococcus aureus, and Escherichia coli. Susceptibilities to gatifloxacin and moxifloxacin were comparable with each other (p=0.312) and with potential susceptibilities to cefazolin-tobramycin (p=0.479), gatifloxacin-cefazolin (p=0.134), and moxifloxacin-cefazolin (p=0.412) combinations.

Conclusions: Monotherapy with moxifloxacin or gatifloxacin can be an effective alternative to cefazolin-tobramycin combination as a first-line empirical therapy for bacterial keratitis. The addition of cefazolin to a fourth-generation fluoroquinolone is of limited value.

Publication types

  • Comparative Study

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Drug Resistance, Multiple, Bacterial*
  • Eye Infections, Bacterial / drug therapy*
  • Eye Infections, Bacterial / epidemiology
  • Eye Infections, Bacterial / microbiology
  • Fluoroquinolones / therapeutic use*
  • Gram-Negative Bacteria / drug effects
  • Gram-Negative Bacteria / isolation & purification
  • Gram-Negative Bacterial Infections / drug therapy*
  • Gram-Negative Bacterial Infections / epidemiology
  • Gram-Negative Bacterial Infections / microbiology
  • Gram-Positive Bacteria / drug effects
  • Gram-Positive Bacteria / isolation & purification
  • Gram-Positive Bacterial Infections / drug therapy*
  • Gram-Positive Bacterial Infections / epidemiology
  • Gram-Positive Bacterial Infections / microbiology
  • Humans
  • Incidence
  • India / epidemiology
  • Keratitis / drug therapy*
  • Keratitis / epidemiology
  • Keratitis / microbiology
  • Microbial Sensitivity Tests
  • Retrospective Studies


  • Anti-Bacterial Agents
  • Fluoroquinolones