The clinical treatment of bacterial keratitis: A review of drop instillation regimes |
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| Affiliation: | 1. John Curtin School of Medical Research, Australian National University (ANU), 131 Garran Rd, Acton, ACT 2601, Australia;2. Academic Unit of Ophthalmology, ANU Medical School, Building 4, The Canberra Hospital, Garran, Canberra, ACT 2065, Australia;3. Department of Ophthalmology, Canberra Hospital, 15 Hospital Road, Garran, Canberra, ACT 2065, Australia;4. Royal Victorian Eye and Ear Hospital, 32 Gisbourne Street, East Melbourne, Melbourne, VIC 3002, Australia;1. Illinois College of Optometry, Chicago, IL, USA;2. OCULUS Inc, Arlington, Washington;3. North Suburban Vision Consultants and International Keratoconus Academy, Deerfield IL, USA;1. Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand;2. École d''optométrie, Université de Montréal, Quebec, Canada;3. Centre for Ocular Research and Education, School of Optometry and Vision Science, University of Waterloo, Ontario, Canada;1. Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States;2. Chemical and Biomolecular Engineering Department, University of California, Berkeley, CA 94720, United States;3. Clinical Research Center, University of California, Berkeley, CA 94720, United States;4. CooperVision Inc., Pleasanton, CA 94588, United States;1. Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;2. Dr. Heiko Pult - Optometry and Vision Science Research, Steingasse 15, 69469 Weinheim, Germany;3. Contact Lens & Anterior Eye Research Unit (CLEAR), School of Biomedical & Life Sciences, Cardiff University, Cardiff, UK;1. Department of Ophthalmology, Princess Alexandra Hospital, Brisbane, Australia;2. School of Health, Medical and Applied Sciences, Central Queensland University, Queensland, Australia;3. Greenslopes Clinical School, University of Queensland School of Medicine, Brisbane, Australia;4. Layton Vision Foundation, Brisbane, Australia |
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| Abstract: | Bacterial keratitis (BK) presentations are often treated using the commercially available second-generation fluoroquinolones ciprofloxacin 0.3% and ofloxacin 0.3% as monotherapy. The guidelines available for instillation regimes are often not supported by data from clinical studies.This review examines the peer-reviewed clinical studies and compared treatment failure rates for ciprofloxacin 0.3% and ofloxacin 0.3% for BK in relation to Day-1 drop-regimes. From the statistical analysis, this review derived evidence-based clinically applicable minimum drop-regimes for the treatment of BK on Day-1.Lower numbers of drops of ciprofloxacin on Day-1 were significantly associated with increased treatment failure rates (p < 0.002). The derived minimum number of drops on Day for ciprofloxacin on Day-1 was 47 drops, and for ofloxacin 24 drops. The mean number of drops used in the clinical studies was significantly lower than the manufacturers’ recommended Day-1 regimes for both ciprofloxacin (p = 0.0006) and ofloxacin (p = 0.048). From Day-3 to ?6 of treatment the drop rates for ciprofloxacin relative to recommended rates were higher, and for ofloxacin lower (p = 0.014).The findings of this review were then compared with a representative sample of published guidelines and case studies to determine the validity of applying those drop-regimes in clinical practice. Although the manufacturers’ suggested minimum drop-regimes on Day-1 were significantly different (120 drops ciprofloxacin, 34 drops ofloxacin, p < 0.0001), many of the published guidelines suggested the same drop-regime for both fluoroquinolones. The suggested drop numbers on Day-1 for ciprofloxacin in these guidelines and case studies were significantly less than those used in the clinical studies (p = 0.043).Increased treatment failure rates for ciprofloxacin are associated with lower drop numbers on Day-1. The Day-1 dosing rates for ciprofloxacin and ofloxacin should be considered separately, and the regimes suggested in published guidelines and case studies may need be re-considered in light of the findings of this review. |
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| Keywords: | Bacterial keratitis Fluoroquinolones Drop-regimes |
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