Сontemporary evidence-based antibiotic management of bacterial keratitis prior to penetrating keratoplasty

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