Сontemporary evidence-based antibiotic management of bacterial keratitis prior to penetrating keratoplasty
DOI: 10.32364/2311-7729-2025-25-3-8
M.Yu. Shemyakin, A.S. Chernakov
Botkin Hospital, Moscow, Russian Federation
The review is dedicated to evaluate efficacy of preoperative antibacterial therapy and a clear corneal graft survival in patients with bacterial keratitis (BK). A search and review (covering 2020–2025) of scientific publications on bacterial keratitis and its management prior to penetrating keratoplasty (PK) were conducted in international databases (PubMed, Web of Science, eLibrary etc.). The review was focused on studies related to changes in causative agents, susceptibility to major classes of topical antibiotics (fluoroquinolones, aminoglycosides, first- and third-generation cephalosporins, vancomycin, and a combination of trimethoprim + polymyxin B), as well as experimental data on Staphylococcus aureus and Pseudomonas aeruginosa biofilm formation on the corneal surface. A shift of etiological BK spectrum toward Corynebacterium spp. and an increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) significantly reduce efficacy of conventional fluoroquinolone monotherapy. The best possible preoperative regimen should include agents active against both MRSA and P. aeruginosa (e.g., vancomycin/netilmicin + ceftazidime or trimethoprim + polymyxin B). Early detection and mechanical/enzymatic disruption of biofilms are critical; without their elimination, even high-dose antibiotic therapy fails to prevent recurrence and graft opacification. Comprehensive antibacterial preparation increases a likelihood of sustained clarity of donor cornea following PK.
Keywords: bacterial keratitis, penetrating keratoplasty, ophthalmic antibiotic resistance, methicillin-resistant Staphylococcus aureus, Corynebacterium, fluoroquinolones, netilmicin, biofilm, debridement.
For citation: Shemyakin M.Yu., Chernakov A.S. Сontemporary evidence-based antibiotic management of bacterial keratitis prior to penetrating keratoplasty. Russian Journal of Clinical Ophthalmology. 2025;25(3):208–214 (in Russ.). DOI: 10.32364/2311-7729-2025-25-3-8
About the authors:
Matvey Yu. Shemyakin — Ophthalmologist at the Ophthalmological Department No. 63, Moscow City Ophthalmological Center, Junior Scientific Officer, Scientific and Clinical Department, Botkin Hospital; 5, 2nd Botkinskiy pass., Moscow, 125284, Russian Federation; ORCID iD 0000-0003-1537-1405
Alexander S. Chernakov — Ophthalmologist, Ophthalmological Department No. 64, Moscow City Ophthalmological Center, Botkin Hospital; 5, 2nd Botkinskiy pass., Moscow, 125284, Russian Federation; ORCID iD 0009 0008 8536 0553
Contact information: Matvey Yu. Shemyakin, e-mail: matvei.shemyakin@gmail.com
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 02.06.2025.
Revised 27.06.2025.
Accepted 22.07.2025.
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