Efficacy of Azithromycin 1% and 1.5% ophthalmic solutions compared to tobramycin 0.3% eye drops: A systematic review and meta-analysis

Abstract

Background: Azithromycin 1% and 1.5% ophthalmic preparations are used widely in clinical practice for the treatment of signs and symptoms of eye diseases. Despite individual studies, there have been no summarized evidence about the efficacy of azithromycin over tobramycin eye drops. Therefore, the aim of this study was to abridge this gap by rendering conclusive evidence by comparing the efficacy of azithromycin 1% and 1.5% over tobramycin 0.3% ophthalmic solutions for the treatment of eye diseases in short duration in terms of bacterial resolution, cure rate and resolving clinical sign and symptoms of eye diseases. Methods: Systematic searches were performed in both electronic (Medline (Ovid), EMBASE (Ovid), Emcare (Ovid), CINAHL (EBSCOhost), Scopus, PubMed, ProQuest, Web of Science and Cochrane Central Register of Controlled Trials) and other sources (Worldcat, Mednar, Google and Google scholar). Multicenter randomized controlled trial studies conducted in the English language were identified and screened. Joanna Briggs Institute quality assessment checklist for randomized controlled trials was used to critically appraise the methodological quality of studies. Analysis of individual studies was conducted using the OpenMeta-analyst and Review manager Version 5.3 software. The study was reported, according to the PRISMA reporting checklist. Results: Eleven studies were included in the systematic review and meta-analysis. In clinical cure rate, Azithromycin 1% and 1.5% eye drops were more effective than tobramycin 0.3% eye drops in short duration dosing (≤ 5 days) with a twice-a-day regimen (RR=1.138; 95% CI:1.008, 1.284) whereas on increased duration (>5days) azithromycin is almost similarly as effective as tobramycin with (RR=1.007; 95% CI: 0.964, 1.052). There was no significant difference in efficacy of bacterial resolution of azithromycin (1%, 1.5%) eye drops compared to tobramycin (0.3%) eye drops (RR=0.992; 95% CI: 0.967, 1.0183). Conclusion: Azithromycin 1% and 1.5% eye drops are more effective in clinical cure rate than tobramycin 0.3% eye drops for short duration treatment. So that it is recommended to use azithromycin instead of tobramycin eye drops to get good result in short duration dosage. Systematic Review Registration ID : CRD42019139911, registered on October 16,2019; https://www.crd.york.ac.uk/PROSPERO/#recordDetails Keywords: Azithromycin, Tobramycin, Efficacy, Eye drops, Eye diseases