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01.12.2016 | Letter to the Editor | Ausgabe 1/2016 Open Access

Journal of Ophthalmic Inflammation and Infection 1/2016

The role of oral co-trimoxazole in treating Nocardia farcinica keratitis—a case report

Journal of Ophthalmic Inflammation and Infection > Ausgabe 1/2016
Neharika Sharma, Stephen O’Hagan
Wichtige Hinweise
A correction to this article is available online at https://​doi.​org/​10.​1186/​s12348-017-0143-2.

Competing interests

The authors declare that they have no competing interests.


The authors do not have any acknowledgements to make.

Authors’ contributions

NS was involved in the management of this patient, performed the literature review, and drafted the manuscript. SOH was involved the management of this patient and played a substantial role in critically revising the manuscript for intellectual content. Both authors read and approved the final manuscript.



Nocardia farcinica is one of the more recently identified species of the Nocardia genus. Nocardia farcinica keratitis is a rare occurrence, with only eight previously reported cases. Semi-permeable rigid contact lens use was associated with one of these reported cases. We report the first case of extended wear soft contact-lens-related Nocardia farcinica keratitis and recommend a new treatment regime.


A 47-year-old lady presented with a right eye keratitis after wearing her extended wear soft contact lenses for five continuous weeks. There was no history of trauma or swimming with contact lenses in. Empirical ciprofloxacin and tobramycin eye drops were not tolerated due to ocular surface irritation on application; and instead, empirical treatment was with chloramphenicol and fortified gentamicin 1.5 % eye drops. Corneal scrapings grew Nocardia farcinica after 3 weeks—sensitive to amikacin and co-trimoxazole. Treatment was changed to amikacin 2.5 % eye drops, resulting in partial resolution of the corneal infiltrates. Oral co-trimoxazole 160/800 mg BD was added, due to cultured drug sensitivity and its high ocular penetration, with good results and a final right eye best-corrected visual acuity of 6/5.


Nocardia farcinica keratitis should be considered in the differential diagnosis of contact-lens-related keratitis. We report the first case occurring in association with extended wear soft contact lenses. Nocardia species can mimic fungal and Acanthamoeba keratitis. Treatment with oral co-trimoxazole has not been previously reported. This case demonstrates a role for co-trimoxazole in treating Nocardia farcinica keratitis based on cultured drug sensitivities.
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