Objective: To estimate how a corneal isolate's minimal inhibitory concentration for a fluoroquinolone agent affects the rate of clinical response of bacterial keratitis to fluoroquinolone therapy.
Design: Prospective cohort study.
Methods: Six hundred sixty-three individuals with suspected bacterial keratitis underwent diagnostic corneal scraping and were treated with topical 0.3% ciprofloxacin solution or ointment. Of 407 patients with culture-confirmed bacterial keratitis, improvement and cure rates with ciprofloxacin monotherapy were estimated for 391 who had in vitro ciprofloxacin susceptibility of the principal corneal isolate.
Main Outcome Measures: Slitlamp biomicroscopic assessment for clinical improvement of corneal inflammation and for clinical cure with complete reepithelialization.
Results: Adjusted rates of improvement and of cure were reduced, respectively, by 43% (95% confidence limits, 8%, 64%) and by 29% (95% confidence limits, 0%, 49%) among corneal infections having a ciprofloxacin minimal inhibitory concentration above 1.0 micro g/mL compared with those with more sensitive isolates.
Conclusions: Corneal infection by relatively ciprofloxacin-resistant bacteria responds more slowly to ciprofloxacin therapy. Antibacterial susceptibility testing of corneal cultures may predict the fluoroquinolone therapeutic response rate of bacterial keratitis.
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