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  Discussion on Research Study: Susceptibility patterns in equine ulcerative keratomycosis
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DrO

Posted on Friday, Nov 20, 2009 - 8:08 am:

As would be expected susceptibility patterns of pathogenic fungus is constantly evolving away from commonly used anti-fungals. However this study found a significant exception with miconazole, a cheap readily available antifungal. Interesting unlike large studies of the past this study did not find geographical differences in pattern of susceptibility. For more information see the article.
DrO

Vet Ophthalmol. 2009 Sep-Oct;12(5):318-24.
In vitro susceptibility patterns of Aspergillus and Fusarium species isolated from equine ulcerative keratomycosis cases in the midwestern and southern United States with inclusion of the new antifungal agent voriconazole.

Pearce JW, Giuliano EA, Moore CP.

Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri-Columbia, 900 East Campus Dr., Columbia, MO 65211, USA.

Abstract Objective To evaluate and compare the in vitro susceptibility of Aspergillus and Fusarium spp. isolated from horses with ulcerative keratomycosis, address regional differences in equine keratomycosis isolates, and provide susceptibility data to update prior studies. Animal studied Fourteen horses with ulcerative keratomycosis. Procedures Banked fungal isolates from equine corneal ulcers (eight Aspergillus spp. and six Fusarium spp.) were identified at The University of Texas Health Science Center at San Antonio. In vitro minimum inhibitory concentration and susceptibility to natamycin, fluconazole, itraconazole, voriconazole, ketoconazole, and miconazole were determined for each isolate. Results Fungi were significantly more susceptible to voriconazole than to natamycin, itraconazole, fluconazole, and ketoconazole, but miconazole susceptibility did not differ significantly from voriconazole. Aspergillus spp. were most susceptible to voriconazole, miconazole, and itraconazole, which were significantly better to fluconazole and ketoconazole. Fusarium spp. susceptibility was greatest to natamycin and voriconazole and lowest to itraconazole and ketoconazole. Fusarium spp. were significantly less susceptible to itraconazole and ketoconazole compared to natamycin. No significant differences in susceptibility were found when isolates from Florida were compared with isolates from other states. Conclusions and clinical relevance Based on in vitro evidence, voriconazole appears to be the most effective antifungal for initial treatment of equine keratomycosis in the midwestern and southern United States. Results are comparable with previous studies in that isolated fungi from equine keratomycosis cases showed consistently poor susceptibility to fluconazole. Organisms isolated in different geographic locations of the midwestern and southern United States appeared to have similar patterns of antifungal susceptibility.
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