Successful Treatment for Methicillinn Resistent Staphylococcus aureus Conjunctivitis Using 1% Povidone Iodine Eye Drop: Two Cases

Abstract

Purpose: Long-term bedridden patients frequently present with refractory chronic conjunctivitis. Multidrug-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), are often isolated; infections caused by such bacteria are treated with vancomycin, although refraining from overuse of this drug is recommended. Bacterial resistance to povidone-iodine (PI) has not been observed; hence, it can be effectively used for treating bacterial infections. However, it has not been popularly used for treating ocular surface infections. We report two cases of multidrug-resistant bacterial conjunctivitis treated with PI. Methods: Case 1: A 90-year-old male hospitalized for pneumonia caused by multidrug-resistant Pseudomonas aeruginosa. Case 2: A 56-year-old male hospitalized for brainstem hemorrhage. In both patients, there were signs of conjunctivitis and MRSA was cultured. To avoid overuse of vancomycin, we started 1% PI instillation thrice daily. Results: Clinical signs of the patients remarkably improved within a week of PI treatment. There were no distinct complications from PI treatment in either case. Conclusions: PI has a wide spectrum, does not induce bacterial resistance, is cheap, and can be obtained worldwide. Though further studies are necessary for wider practical use in clinical settings, PI ocular instillation is a reasonable option for treating ocular surface infections caused by multidrug-resistant bacteria, which are overseen by many general ophthalmologists.