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Ceftazidime/natamycin Toxic keratopathy and corneal toxicity: case report

A 38-day-old male infant developed toxic keratopathy and corneal toxicity during empiric treatment with ceftazidime and natamycin for keratitis. The male infant was admitted to the neonatal ICU at hospital in china on 24 February 2017 for secondary infectious keratitis and exposure keratitis of the left eye. Based on the findings of left eye examination the differential diagnosis of bacterial keratitis, exposure keratitis or mycotic keratitis was made. Subsequently, he started receiving empiric treatment with topical 5% natamycin eye drops every 6 hours along with levofloxacin, erythromycin and fluconazole. On 27 February 2017, he presented with a ringshaped stromal infiltration, a 2mm hypopyon, deep corneal ulcer and the lesion in the left eye had deteriorated. The male infant’s treatment with natamycin and fluconazole was discontinued. Thereafter, he was treated with erythromycin every hour and levofloxacin every 2 hours. On 1 March 2017, the corneal ulcer appeared slightly shallower; however, the depth of hypopyon and stromal infiltration had not changed. Therefore, it was concluded that the primary broad-spectrum antibacterials had little effect on the corneal lesion. After consulting with a physician, his treatment with levofloxacin and erythromycin was switched to 5% ceftazidime eye drops and tobramycin every hour. On the next day, full-thickness stromal infiltration, a total corneal epithelial defect, peripheral corneal melting and ulceration of the anterior two-thirds of the cornea was observed. During this time, neither fungi nor bacteria had been cultured from the corneal scrapings. All previously administered drops were discontinued and replaced with preservative-free artificial tears, erythromycin eye ointment and levofloxacin eye drops. Over the next 20 days following the discontinuation of ceftazidime, his symptoms improved. Based on these findings and clinical presenatation it was concluded that he developed toxic keratopathy and corneal toxicity associated with ceftazidime and natamycin [not all duration of treatments to reactions onset clearly stated]. The frequency of topical medication was reduced gradually. On 29 March 2017, double mandibular distraction osteogenesis was performed. During postoperative follow-up, it was observed that the cornea was largely transparent, left eyelid closure had maintained and in the center of the cornea a small scar was present. Eventually, 4 weeks after the operation in April 2017, he died due to multiple organ failure. Chen W, et al. Severe toxic keratopathy after topical natamycin and ceftazidime use. Panminerva Medica 61: 507-508, No. 4, Dec 2019. Available from: URL: http:// doi.org/10.23736/S0031-0808.19.03615-2

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Reactions 19 Sep 2020 No. 1822