The use of miltefosine in the management of refractory  Acanthamoeba  keratitis

Tavassoli, Shokufeh; Buckle, Miranda; Tole, Derek; Chiodini, Peter L.; Darcy, Kieren

doi:10.1016/j.clae.2018.03.007

Cited by 21 publications

(11 citation statements)

References 9 publications

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“…Miltefosine is a recently approved option for treatment-resistant AK with activity against both the trophozoite and cystic forms, which has shown promise in otherwise refractory cases [ 11 ]. Notably, it was originally developed in the 1980s as an antineoplastic agent; however, levels required to be sufficiently antineoplastic would be nearly universally lethal [ 12 ]. Its mechanism of action is not fully understood; however, it mimics the structure of membrane phospholipids with notable omission of glycerol.…”

Section: Discussionmentioning

confidence: 99%

Acanthamoeba Keratitis: A Single-Institution Series of Four Cases With Literature Review

Smith¹,

Ashraf²,

Haghnegahdar³

et al. 2022

Cureus

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Acanthamoeba species are free-living protozoa found pervasively in water and soil, which can cause infections of the central nervous system, skin, and eye. Amoebic keratitis (AK) is a vision-threatening, often chronic infection that is associated with the use of soft contact lenses due to corneal microtrauma and improper cleaning and storage. Although AK infections are rare, they cause significant morbidity including vision loss due to the diagnostic and therapeutic challenges they pose.The clinical course is determined by the organism's inherent pathogenicity, delay of diagnosis, and the paucity of data on effective therapeutic regimens. The case series and review of literature that follows examine current latest best practices in AK diagnosis including in vivo confocal microscopy (IVCM) and therapeutic interventions including miltefosine.

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Section: Discussionmentioning

confidence: 99%

Acanthamoeba Keratitis: A Single-Institution Series of Four Cases With Literature Review

Smith¹,

Ashraf²,

Haghnegahdar³

et al. 2022

Cureus

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“…In addition, they found that miltefosine had no negative effect on cell viability 14 . Recently, Tavassoli et al reported the first use of oral miltefosine in a patient with refractory Acanthamoeba keratitis in the United Kingdom 7 . They used a dose of 50 mg 3 times a day and started the medication two weeks before planned enucleation to minimize extra-ocular spread.…”

Section: Discussionmentioning

confidence: 99%

“…There is very limited data on the use of oral miltefosine for Acanthamoeba keratitis in humans. There has only been one previous case report of the use of systemic miltefosine for the treatment of Acanthamoeba keratitis and scleritis prior to enucleation to reduce the risk of extraocular spread 7 …”

Section: Discussionmentioning

confidence: 99%

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Oral miltefosine for refractory Acanthamoeba keratitis

Hirabayashi

Lin

2019

American Journal of Ophthalmology Case Reports

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PurposeTo report the first case of Acanthamoeba keratitis treated with oral miltefosine in the United States.ObservationsA 17-year-old female with a history of orthokeratology contact lens wear presented after five months of left eye pain, redness, and photophobia. She was previously treated with antivirals and topical corticosteroids for presumed herpetic disease. She was found to have a large central ring infiltrate and corneal cultures were positive for Acanthamoeba. The infection progressed despite hourly PHMB 0.02% and chlorhexidine 0.02%, and oral vorizonazole. The patient was started on oral miltefosine 50 mg 3 times per day. Following one week of treatment, repeat cultures were positive for Acanthamoeba and therefore, the concentration of chlorhexidine was increased from 0.02% to 0.06% and PHMB was changed to propamidine isetionate (Brolene 0.1%). There was definite clinical improvement after five weeks of treatment with oral miltefosine, topical chlorhexidine 0.06% and propamidine isetionate 0.1%.Conclusions and importanceAcanthamoeba keratitis is a challenging entity to treat and often associated with a poor prognosis. Oral miltefosine may offer additional therapeutic benefit in cases of refractory Acanthamoeba keratitis.

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“…13,14 Miltefosine (hexadecylphosphocholine), an alkylphosphocholine, showed interesting results too, in topical 15 and systemic therapy. 16 The development of antiacanthamoebic agents remains a challenge in order to improve the visual prognosis of the disease. Titanium dioxide (TiO 2 ) is a fine crystal powder.…”

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confidence: 99%