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PubMed2004

[Bacterial conjunctivitis: most prevalent pathogens and their antibiotic sensitivity].

INTRODUCTION: Bacterial conjunctivitis is a self-limiting process, but topical antibiotic treatment is recommended to eradicate the pathogen and reduce symptom duration. Since this treatment is usually empirical and prior cultures are not normally taken, the etiological agents involved in the process are unknown. PATIENTS AND METHODS: A total of 596 conjunctival exudates from pediatric outpatients with a diagnosis of acute conjunctivitis in Medical Area 6 of Madrid, Spain, were studied over 3 years (from 2000 to 2002 inclusive). The patients were divided into three age groups: group 1 (infants), group 2 (2- to 6-year-olds) and group 3 (7- to 14-year-olds). RESULTS: A total of 428 bacteria were isolated. The most prevalent bacteria were Haemophilus influenzae (44.8 %) and Streptococcus pneumoniae (30.6 %) followed by Staphylococcus aureus (7.5 %), S. viridans (7.2 %), Moraxella catarrhalis (6.8 %) and Enterobacteriaceae (4.2 %). In 56 exudates (15.1 %), two or more bacteria were isolated and S. pneumoniae 1 H. influenzae were found in 8.1 % of the cases. By age group, S. aureus was significantly more prevalent (p < 0.0001) in group 3 than in groups 1 and 2. Isolation of Enterobacteriaceae, S. viridans and non-fermentative Gram negative bacilli was significantly more frequent (p < 0.05) in group 1 and isolation of S. pneumoniae (p < 0.05) was significantly more frequent in group 2. S. pneumoniae showed the greatest level of resistance to antibiotics used in eye drops and ophthalmic ointments. Ciprofloxacin, chloramphenicol and rifampin were active in the most prevalent pathogens. CONCLUSIONS: The most prevalent bacteria were H. influenzae and S. pneumoniae. The most active antibiotics in these pathogens were ciprofloxacin, chloramphenicol and rifampin.

Adolescent↗

PubMed2002

Treatment of acute neonatal bacterial conjunctivitis: a comparison of fucidic acid to chloramphenicol eye drops.

PURPOSE: To compare the clinical and bacteriological effects of fucidic acid (Fucithalmic: 1.0%) and chloramphenicol (Minims(R): 0.5%) eye drops in neonates with a clinical diagnosis of acute conjunctivitis of suspected bacterial origin. METHODS: A TOTAL OF 456 N: ewborns with gestational age > 32 weeks with acute conjunctivitis of suspected bacterial origin acquired within the first 28 days of life were included in the study. They were randomly assigned to a 7-day treatment with eye drops using either fucidic acid (1.0%) (Fucithalmic) applied twice per day, or chloramphenicol (0.5%) (Minims Chloramphenicol) applied six times per day. The subjects were followed up with two visits (on days 1 and 8) and by telephone 2 weeks after the end of treatment. RESULTS: Eighty-nine per cent of the neonates treated with Fucithalmic were cured, compared to 87.9% of those treated with Minims Chloramphenicol (n.s). The drug was used as instructed in 90.7% of patients treated with Fucithalmic and in 78.0% of those treated with Minims Chloramphenicol (P < 0.001). CONCLUSION: Treating neonatal conjunctivitis with fucidic acid is easier than with chloramphenicol and is equally effective.

Acute Disease↗

PubMed2005

Clinical safety of moxifloxacin ophthalmic solution 0.5% (VIGAMOX) in pediatric and nonpediatric patients with bacterial conjunctivitis.

Five independent, multicentered, double-masked, parallel, controlled studies were conducted to determine the safety of moxifloxacin ophthalmic solution 0.5% (VIGAMOX) in pediatric and nonpediatric patients with bacterial conjunctivitis. Patients were randomized into one of two treatment groups in each study and received either moxifloxacin ophthalmic solution 0.5% b.i.d. or t.i.d. or a comparator. A total of 1,978 patients (918 pediatric and 1,060 nonpediatric) was evaluable for safety. The most frequent adverse event in the overall safety population was transient ocular discomfort, occurring at an incidence of 2.8%, which was similar to that observed with the vehicle. No treatment-related changes in ocular signs or visual acuity were observed with moxifloxacin ophthalmic solution 0.5%, except for one clinically relevant change in visual acuity. Thus, based upon a review of adverse events and an assessment of ocular parameters, moxifloxacin ophthalmic solution 0.5% formulated without the preservative, benzalkonium chloride, is safe and well tolerated in pediatric (3 days-17 years of age) and nonpediatric (18-93 years) patients with bacterial conjunctivitis.

Adult↗

PubMed2003

Efficacy and safety of 0.5% levofloxacin ophthalmic solution for the treatment of bacterial conjunctivitis in pediatric patients.

PURPOSE: To compare the efficacy and safety of 0.5% levofloxacin ophthalmic solution (Quixin; Santen, Napa, CA) with 0.3% ofloxacin (Ocuflox; Allergan Inc., Irvine, CA) and placebo for the treatment of pediatric bacterial conjunctivitis. METHODS: This study was a subset analysis of 167 pediatric patients (age range, 1 to 16 years) from two randomized, double-masked, multicenter, parallel group studies. Eye drops were instilled every 2 hours on days 1 and 2 and every 4 hours on days 3 through 5. Ocular signs and symptoms were noted, and conjunctival cultures were obtained on day 1 (baseline), days 3 to 5 (interim), and days 6 to 10 (final). Endpoint was defined as the last evaluable observation. Microbial and clinical outcomes were based on culture results and cardinal signs, respectively. RESULTS: At endpoint (mean of 6.5 days for 118 evaluable patients), 0.5% levofloxacin treatment demonstrated greater microbial eradication rates (percentage of patients with absence of causative organisms cultured at baseline) compared with 0.3% ofloxacin or placebo. In children age 2 to 11 years, this finding was statistically significant in favor of 0.5% levofloxacin (87% vs 62% with 0.3% ofloxacin [P < or =.032] and 88% vs 24% with placebo [P <.001]). No significant differences between treatment groups in microbial eradication rates were noted in other age subgroups. CONCLUSIONS: After 5 days of therapy, 0.5% levofloxacin ophthalmic solution was found to be safe and effective in treating pediatric bacterial conjunctivitis. Treatment with 0.5% levofloxacin achieved microbial eradication rates in children that were statistically superior to those attained with 0.3% ofloxacin or placebo.

Adolescent↗

PubMed1989

Viral and bacterial conjunctivitis. Prevention of disastrous results.

Conjunctivitis has many bacterial and viral causes. If the cause is bacterial, treatment with a broad-spectrum antibiotic resolves the problem in 1 to 3 days in almost all cases. If signs and symptoms persist, referral to an ophthalmologist is wise. Most cases of viral conjunctivitis are accompanied by follicular reactions in the inferior fornix, as observed with adult inclusion disease. If dendrites are seen, trifluridine (Viroptic) is preferred for treatment. Referral to an ophthalmologist is advisable because recurrence with scarring and permanent loss of vision is possible. Many topical antibiotics include a corticosteroid component that never should be used unless the conjunctivitis or keratitis is proven to be nonherpetic.

Adult↗

PubMed2002

Treatment of acute bacterial conjunctivitis with topical netilmicin.

PURPOSE: This study compares the clinical and microbiologic value of topical netilmicin with that of gentamicin in the treatment of acute bacterial conjunctivitis. METHODS: A double-blind, randomized, prospective, controlled study was performed in 209 patients. One to two drop(s) of either antibiotic was applied to the affected eye(s) four times a day for up to 10 days. Patients were examined at the time of diagnosis and after 3, 5, and 10 days. Clinical efficacy was measured as the cumulative sum score (CSS) of the key signs and symptoms of acute bacterial ocular infection. Sensitivity/resistance was evaluated using the disk diffusion method. RESULTS: Drug efficacy assessment was restricted only to patients with positive baseline culture results (n = 121). Of the isolated organisms, 96.9% were sensitive to netilmicin, whereas only 75.0% were sensitive to gentamicin (p = 0.00001). Netilmicin provided a broad-spectrum coverage comparable with that of ciprofloxacin, ofloxacin, and norfloxacin. Netilmicin also was more effective than gentamicin in eradicating infections (p = 0.001 at day 5 and p = 0.037 at day 10) and in ameliorating the CSS (p = 0.037 at day 3, p = 0.001 at both day 5 and day 10). Only minor adverse events occurred in patients treated with either netilmicin or gentamicin. CONCLUSIONS: This study demonstrates that netilmicin is a safe and effective antibiotic that can be used as first-line therapy for the treatment of acute bacterial conjunctivitis.

Acute Disease↗

PubMedDate not supplied

Efficacy of norfloxacin in bacterial conjunctivitis.

We investigated the efficacy and safety of norfloxacin 0.3% ophthalmic solution in 120 patients with bacterial conjunctivitis or blepharitis. Patients were selected for the study if they showed conjunctival hyperemia and at least three of the following criteria: a) symptoms of a surface ocular infection; b) a purulent discharge; c) crusting of the eyelids, and d) thickened, red lid margins. After taking a specimen for culture from the conjunctiva or skin-lash margin, the test drug was administered to the infected eye every two hours for one day, then 4 times daily for one week. Of the 120 patients who entered the study, 84.1% were cured. No serious adverse reactions occurred.

Adolescent↗

PubMed1988

Trimethoprim-polymyxin B sulphate ophthalmic ointment in the treatment of bacterial conjunctivitis: a double-blind study versus chloramphenicol ophthalmic ointment.

Forty-two patients with a clinical diagnosis of bacterial conjunctivitis were enrolled in a randomized, double-blind trial. Patients were treated with either trimethoprim-polymyxin B sulphate or chloramphenicol ophthalmic ointments 4-times a day for 7 days. Analysis of clinical evaluation data showed that both treatments were effective and well tolerated, and that there were no statistically significant differences between them with regard to eradication of organisms or clinical improvement.

Adolescent↗

PubMedDate not supplied

A clinical comparison of two formulations of tobramycin 0.3% eyedrops in the treatment of acute bacterial conjunctivitis.

PURPOSE: To compare the safety and efficacy of a new enhanced viscosity ophthalmic formulation of tobramycin, given twice daily (BID), with the existing four times daily (QID) treatment regimen in patients with acute bacterial conjunctivitis. METHODS: This was a 12-day, multicenter, observer-masked, randomized, parallel group study. Patients received one drop of tobramycin 0.3% (3 mg/mL) enhanced viscosity ophthalmic solution BID or tobramycin 0.3% (3 mg/mL) ophthalmic solution QID in the affected eyes for 7 days. The primary efficacy variable was the percentage of patients with sustained cure/presumed bacterial eradication based on clinical judgment at the test-of-cure visit (Day 12). Pretherapy bacterial isolates were obtained and tested for susceptibility to tobramycin by determination of minimum inhibitory concentrations (MIC). RESULTS: A total of 276 patients were enrolled in the study and 203 of these were culture positive and attended all follow-up examinations. In this group, 98% of those treated with tobramycin enhanced viscosity ophthalmic solution and 99% of those treated with tobramycin 0.3% ophthalmic solution were categorized as having sustained cure/presumed eradication at the test-of-cure visit (p = 0.6037). Reported adverse events were not serious, mild to moderate in severity, and generally did not prevent continuation in the study. Several pre treatment pathogens demonstrated tobramycin resistance (MIC > 4 mg/mL). However, therapy with both treatments was effective in the majority of the cases. CONCLUSIONS: Tobramycin enhanced viscosity ophthalmic solution is well tolerated and has equivalent efficacy to the established treatment regimen with a simplified posology. The formulation provides an alternative therapy for acute bacterial conjunctivitis that should improve patient compliance and satisfaction.

Acute Disease↗

PubMed2006

Clinical features of bacterial conjunctivitis in children.

OBJECTIVES: Conjunctivitis is a common cause of primary care and emergency department (ED) visits. There is a paucity of data in recent literature on the prevalence of pediatric bacterial conjunctivitis, and there are no evidence-based clinical guidelines for empirical treatment. The study objective was to describe clinical features most predictive of bacterial conjunctivitis. METHODS: This was a prospective study in a children's hospital ED. Conjunctival swabs for bacterial culture were obtained from patients aged 1 month to 18 years presenting with red or pink eye and/or the diagnosis of conjunctivitis. RESULTS: A total of 111 patients were enrolled over one year. Patients had a mean (+/-SD) age of 33.2 (+/-37.5) months, and 55% were male. Eighty-seven patients (78%) had positive bacterial cultures. Nontypeable Haemophilus influenzae accounted for 82% (71/87), Streptococcus pneumoniae for 16% (14/87), and Staphylococcus aureus for 2.2% (2/87). Five clinical variables were significantly associated with a positive bacterial culture. Regression analysis revealed that the combination of a history of gluey or sticky eyelids and the physical finding of mucoid or purulent discharge had a posttest probability of 96% (95% confidence interval = 90% to 99%). Subjective scoring by physicians for a positive culture was 50.6%. CONCLUSIONS: Conjunctivitis in children is predominantly bacterial, with nontypeable H. influenzae being the most common organism. A history of gluey or sticky eyelids and physical findings of mucoid or purulent discharge are highly predictive of bacterial infection. Based on the above data, empirical ophthalmic antibiotic therapy may be appropriate in children presenting with conjunctivitis.

Adolescent↗

PubMed2005

Topical antibiotics for acute bacterial conjunctivitis: Cochrane systematic review and meta-analysis update.

BACKGROUND: Uncertainty remains about the extent to which findings from our previously published systematic review and meta-analysis of double-blind, randomised controlled trials of topical antibiotics compared with placebo in the management of patients with acute bacterial conjunctivitis treated in secondary care outpatient settings are generalisable to the management of the condition in primary care settings. We updated our review, undertaking searches, methodological assessment, data extraction and analysis according to a pre-defined protocol. In addition to the previous three included studies, we identified two additional double-blind primary care trials, one which compares fusidic acid gel with placebo gel and one which compares chloramphenicol eye drops with placebo eye drops in children. Meta-analyses of clinical and microbiological remission data reveal that topical antibiotics are of benefit in improving early (days 2-5) clinical (relative risk [RR] = 1.24, 95% confidence interval [CI] = 1.05 to 1.45) and microbiological (RR = 1.77, 95% CI = 1.23 to 2.54) remission rates; later (days 6-10) data reveal that these early advantages in clinical (RR = 1.11, 95% CI = 1.02 to 1.21) and microbiological cure rates are reduced (RR 1.56, 95% CI = 1.17 to 2.09), but persist. Most cases of acute bacterial conjunctivitis resolve spontaneously. While topical antibiotics are associated with significantly improved rates of early (days 2-5) clinical remission, this benefit is marginal for later remission (days 6-10).

Acute Disease↗

PubMed2003

Preparation of in situ-forming ophthalmic gels of ciprofloxacin hydrochloride for the treatment of bacterial conjunctivitis: in vitro and in vivo studies.

Sol-to-gel systems of ciprofloxacin hydrochloride were prepared utilizing the phase transition properties of hydroxy propyl methyl cellulose K 15 M grade (HPMC) and carbopol 934. The sol-to-gel systems were sterilized by gamma radiation and/or filtration. The sol-to-gel systems were evaluated for rheological characteristics, in vitro release behavior, microbial efficacy, in vivo release behavior, and efficacy against induced bacterial conjunctivitis in rabbits' eyes. Concentration in aqueous humor was determined and stability studies were carried out as per the ICH guidelines. The system passed the test for sterility. The sol-to-gel system exhibited a zero-order drug release pattern over 24 h in in vitro release studies. The drug was active against selected microorganisms in microbial efficacy studies. Better improvement in artificially induced bacterial conjunctivitis in rabbits' eyes was observed in animals treated with the sol-to-gel system compared with marketed eye drops. Drug concentration in aqueous humor was greater than the minimum inhibitory concentration (MIC 90) against selected microorganisms. The shelf-life of the product was >2 years.

Algorithms↗

PubMed1982

Trimethoprim-polymyxin ophthalmic solution versus chloramphenicol ophthalmic solution in the treatment of bacterial conjunctivitis.

Forty patients with a diagnosis of presumptive bacterial conjunctivitis were treated with either trimethoprim-polymyxin or chloramphenicol ophthalmic solutions in a randomized, double-blind trial. No significant differences could be demonstrated between the results of 7-days' treatment with the two preparations and both solutions were found to be effective in improving the signs and symptoms of surface ocular bacterial infection. No adverse reactions were reported in either treatment group.

Adolescent↗

PubMed1999

Topical lomefloxacin 0.3% twice daily versus tobramycin 0.3% in acute bacterial conjunctivitis: A multicenter double-blind phase III study.

AIMS/BACKGROUND: To evaluate in a double-masked comparative, prospective, randomized multicenter trial the efficacy of lomefloxacin 0.3% eye drops twice daily and of tobramycin eye drops 4 times daily in patients with acute bacterial conjunctivitis. METHODS: Ninety-nine subjects were enrolled: 50 were treated with lomefloxacin 0.3% eye drops twice daily and 49 with tobramycin 0.3% eye drops 4 times daily. In all patients, conjunctival swabbing and assessment of objective signs and of subjective symptoms were performed. RESULTS: There was no statistical difference for any individual sign or symptom or for the sum score of either key or other signs and symptoms at any of the examination days. The sum score of both key and other signs and symptoms decreased in both groups at day 3-4 as compared to baseline values (p < 0.0001). The decrease in both these scores continued significantly from day 3-4 to day 7-8 (p < 0.05) and was similar in the two treatment groups (p > 0.4). The lowest resistance rate was seen in lomefloxacin (3.5%) and in neomycin (7.0%), while tobramycin showed resistance in 10 out of 88 resistance strains (11.4%). CONCLUSION: Both lomefloxacin 0.3% twice daily and tobramycin 0.3% administered 4 times daily were well tolerated and showed a high degree of clinical and microbiological efficacy in the treatment of acute bacterial conjunctivitis. Lomefloxacin caused less resistance than other antibiotics evaluated.

Acute Disease↗

PubMed1989

Trimethoprim-polymyxin B sulphate ophthalmic ointment versus chloramphenicol ophthalmic ointment in the treatment of bacterial conjunctivitis--a review of four clinical studies. The Trimethoprim-Polymyxin B Sulphate Ophthalmic Ointment Study Group.

Five hundred and twenty-eight patients with a clinical diagnosis of bacterial conjunctivitis were enrolled in four randomized, double-blind, parallel studies. Patients were treated with trimethoprim-polymyxin B sulphate (TP) or chloramphenicol ophthalmic ointments, four times a day for seven days in three studies, and three times a day for five days in one. Data suitable for evaluation of efficacy and safety were obtained from 448 patients. The results of each study were analysed separately and indicated that both treatments were effective and well tolerated and that there were no statistically significant differences between them. However, in three studies, efficacy trends generally favoured TP ophthalmic ointment and in one study efficacy trends favoured chloramphenicol ophthalmic ointment. A wide range of pathogenic or potentially pathogenic organisms was isolated, with Haemophilus influenzae being the most prevalent.

Adolescent↗

PubMed2000

The evolution of antibiotic therapy for bacterial conjunctivitis and keratitis: 1970-2000.

The editors of this Festschrift asked us to review the use of antibiotics for the treatment of bacterial conjunctivitis and keratitis over the past 25 years, a period coinciding with the life of the Castroviejo Corneal Society. We believe it is more appropriate to begin our review in the late 1960s. about the time that experimental and clinical studies and algorithms for the clinical care derived from these studies helped shape a more rigorous approach to therapy. Those years saw the introduction of antibiotics that were adapted for ophthalmic use, many of which are still being used today. We will give more weight to our review of keratitis than conjunctivitis.

Anti-Bacterial Agents↗

PubMedDate not supplied

Controlling contagious bacterial conjunctivitis.

BACKGROUND: Recent outbreaks (epidemics) of Streptococcus pneumoniae conjunctivitis, involving hundreds of patients, underscore the importance of following recommended guidelines to minimize disease transmission. These include the use of antimicrobial agents capable of minimizing patients' symptoms and the duration of the infectious period when disease can be transmitted to others. PURPOSE: To compare the amount of time required forvarious antibiotic solutions to kill S. pneumoniae, a common cause of bacterial conjunctivitis. MATERIALS AND METHODS: Isolates of S. pneumoniae from three patients were exposed to selected ophthalmic antibiotic products: moxifloxacin 0.5%, tobramycin 0.3%, gentamicin 0.3%, and polymyxin B 10,000 IU-trimethoprim 1.0%. The products were diluted 1:100 and 1:1000 for testing. At 15, 30, 60, 120, and 180 minutes after exposure, aliquots of broth were withdrawn, the cells were separated and cultured, and the viable cell count was determined. RESULTS: Moxifloxacin killed actively growing S. pneumoniae faster and to a greater extent than did the other three antibiotic products when tested at concentrations corresponding to tear film concentrations 5 to 10 minutes and 30 to 60 minutes after instillation of the products. CONCLUSIONS: Moxifloxacin killed S. pneumoniae in vitro faster than did the other antibiotics. Consequently, its use should complement other generally accepted measures for minimizing patients' symptoms and limiting the contagiousness of bacterial conjunctivitis. Also, this is consistent with the recommendations of other investigators to prescribe the most recent generation of fluoroquinolone antibiotics for the specific purpose of limiting the spread of bacterial resistance.

Anti-Bacterial Agents↗

PubMed1991

Antibacterial effectiveness of ciprofloxacin 0.3% ophthalmic solution in the treatment of bacterial conjunctivitis.

Two hundred eighty-eight cases of culture-proven bacterial conjunctivities were evaluated as part of two multicentered, randomized, prospective clinical studies comparing the antibacterial efficacy of topically administered ciprofloxacin 0.3% either with a placebo or with tobramycin 0.3%. In the first study, ciprofloxacin was significantly (P less than .001) more effective than the placebo. It eradicated or reduced the various bacterial pathogens in 93.6% of patients, compared to 59.5% for the placebo. In the second study, ciprofloxacin (94.5%) and tobramycin (91.9%) were equally effective. Topically applied ciprofloxacin eradicated or reduced all isolated bacterial species, attesting to its broad antibacterial spectrum and its potential usefulness in treating external ocular infections.

Anti-Bacterial Agents↗