Current perspectives on natamycin in ocular fungal infections

Currently, natamycin ophthalmic suspension (Natacyn®) is the only commercially available antifungal agent that has been approved in the treatment of superficial fungal infections of the eye such as fungal keratitis, blepharitis, and conjunctivitis. Despite natamycin requiring frequent application due to low retention at the ocular surface, it has shown efficacy in treating superficial ophthalmic fungal infections. This is attributed to its broad antifungal spectrum against filamentous fungi, safety profile, and its trans-corneal penetration capability. The ability of natamycin to traverse across the intact cornea and reach adjacent stromal layers has been credited to be one of the major factors favoring its continued use in superficial fungal infections over other antifungal agents such amphotericin B and azole class of antifungals, which can only penetrate the debrided cornea, but not intact cornea, to elicit their activity. This has led to natamycin being one of the front-line agents in the therapy of superficial ocular fungal infections. This review discusses various aspects of natamycin such as its chemistry and pharmacology, antifungal spectrum and potential for development of resistance, ocular clinical evaluations, and specifics on the marketed natamycin formulation (Natacyn®) to obtain a perspective of natamycin use in ophthalmic fungal infections.

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