Topical antibiotics for the management of bacterial keratitis: an evidence-based review of high quality randomised controlled trials

McDonald, Elissa M; Ram, Felix S F; Patel, Dipika V.; McGhee, Charles N J

doi:10.1136/bjophthalmol-2013-304660

Cited by 101 publications

(76 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The authors found no significant difference in the relative risk of treatment success defined as complete re-epithelialization of the cornea or on time to cure. 30 While there was an increase in the relative risk of minor adverse events such as ocular discomfort or chemical conjunctivitis with aminoglycoside-cephalosporin compared with fluoroquinolones, there was no difference in serious complications. 30–33,34 …”

Section: Bacterial Keratitismentioning

confidence: 95%

Update on the Management of Infectious Keratitis

2017

View full text Add to dashboard Cite

Infectious keratitis is a major global cause of visual impairment and blindness, often affecting marginalized populations. Proper diagnosis of the causative organism is critical, and while culture remains the prevailing diagnostic tool, newer techniques such as in vivo confocal microscopy are helpful for diagnosing fungal keratitis and Acanthameoba. Next generation sequencing holds the potential for early and accurate diagnosis even for organisms that are difficult to culture by conventional methods. Topical antibiotics remain the best treatment for bacterial keratitis, and a recent review found all commonly prescribed topical antibiotics to be equally effective. However outcomes remain poor secondary to corneal melting, scarring and perforation. Adjuvant therapies aimed at reducing the immune response responsible for much of the morbidity associated with keratitis include topical corticosteroids. The large, randomized controlled Steroids for Corneal Ulcers trial found that while steroids provided no significant improvement overall, they did appear beneficial for ulcers that were central, deep or large, non-Nocardia or classically invasive P. aeruginosa, patients with low baseline vision, and when started early after the initiation of antibiotics. Fungal ulcers often have worse clinical outcomes than bacterial ulcers, with no new treatments since the 1960’s when topical natamycin was introduced. The randomized controlled Mycotic Ulcer Treatment Trial showed a benefit of topical natamycin over topical voriconazole for fungal keratitis, particularly among those caused by Fusarium. The second Mycotic Ulcer Treatment Trial showed that oral voriconazole did not improve outcomes overall although there may have been some effect among Fusarium ulcers. Given an increase in non-serious adverse events the authors concluded that they could not recommend oral voriconazole at this time. Viral keratitis differs from bacterial and fungal cases in that is often recurrent and is common in developed countries. The first Herpetic Eye Disease Study (HEDS) showed a significant benefit of topical corticosteroids and oral acyclovir for stromal keratitis. HEDS II showed that oral acyclovir decreased the recurrence of any type of HSV keratitis by approximately half. Future strategies to reduce the morbidity associated with infectious keratitis are likely to be multidimensional with adjuvant therapies aimed at modifying the immune response to infection holding the greatest potential to improve clinical outcomes.

show abstract

Section: Bacterial Keratitismentioning

confidence: 95%

Update on the Management of Infectious Keratitis

2017

View full text Add to dashboard Cite

show abstract

“…While awaiting cultures, empiric treatment should be started immediately and the antibiotic chosen should be of sufficiently broad spectrum to cover likely pathogens based on local bacterial prevalence and antibiotic susceptibilities. [2] Since regional differences exist in the etiologies of bacterial keratitis[3,4], good local epidemiological data are needed for better empirical treatment of bacterial keratitis.…”

Section: Introductionmentioning

confidence: 99%

Trends of Bacterial Keratitis Culture Isolates in Jerusalem; a 13- Years Analysis

et al. 2016

View full text Add to dashboard Cite

PurposeTo describe the trends in pathogens and antibacterial resistance of corneal culture isolates in infectious keratitis during a period of 13 years at Hadassah-Hebrew University Medical Center.MethodsA Retrospective analysis of bacterial corneal isolates was performed during the months of January 2002 to December 2014 at Hadassah Hebrew University Medical Center. Demographics, microbiological data and antibiotic resistance and sensitivity were collected.ResultsA total of 943 corneal isolates were analyzed during a 13 year period. A total of 415 positive bacterial cultures and 37 positive fungal cultures were recovered, representing 48% of the total cultures. The Annual incidence was 34.78 ± 6.54 cases. The most common isolate was coagulase-negative staphylococcus (32%), which had a significant decrease in trend throughout the study period (APC = -8.1, p = 0.002). Methicillin-resistant Staphylococcus aureus (MRSA) appears to have a decrease trend (APC = -31.2, P = 0.5). There was an increase in the resistance trend of coagulase-negative staphylococci to penicillin (APC = 5.0, P = <0.001). None of the pathogens had developed any resistance to Vancomycin. (P = 0.88).ConclusionsCoagulase negative staphylococci were the predominant bacteria isolated from patients with keratitis. There was no significant change in the annual incidence of cases of bacterial keratitis seen over the past 13 years. Keratitis caused by MRSA appeared to decrease in contrast to the reported literature.

show abstract

“…Dolayısıyla oküler yüzeye ciddi toksik etki gösterirler. 6 Kuru göz hastalarında bu durum hem azalmış yıkama etkisi hem de azalmış epitelyotrofik faktörler (epidermal büyüme faktörü, fibronektin, vitamin A, nörotrofik büyüme faktörleri) nedeni ile daha belirgindir. Bu hastalarda sadece suni gözyaşı desteği yeterli olmayabilir ve bu aktif komponentlerin replasmanı gerekebilir.…”

Section: Discussionunclassified