The authors report on the results of a randomised controlled trial comparing commercially available non-preserved moxifloxacin 0.5% vs. a combination of fortified cefazolin 5% and tobramycin 1.3% in the treatment of moderate bacterial keratitis without perforation. Corneal scrapings were collected from the base and edges of the infiltrate; these were examined with Gram stain and also plated on culture plates of blood agar, chocolate agar, Saboraud’s agar and thioglycolate broth. After randomisation, study participants used the antibiotics hourly day and night for the first 72 hours. Thereafter, the frequency was reduced to two hourly for the next seven days, following which they were tapered according to clinical improvement. No steroids were used. Patients were examined at baseline, days one, four, seven, 14, and 21, as well as at three months. Anterior segment photographs were taken at each visit. Healing was deemed to have occurred once the epithelial defect had closed and the stromal infiltrate had resolved at or before three months. One hundred and ten patients treated with tobramycin and cefazolin and 108 patients treated with moxifloxacin completed the three month follow-up period. The commonest bacteria isolated were coagulase-negative Staphylococcus, Staphylococcus aureus and Pseudomonas aeruginosa – the proportion of these bacteria isolated was similar in both treatment groups. Baseline characteristics, including risk factors such as trauma, contact lens use and lagophthalmos, were not statistically significantly different between both groups. In terms of outcome, there were no statistically significant differences between the proportion of patients that achieved healing and the proportion that got worse. The mean time to re-epithelialisation was also not significantly different between groups. Additionally, there were no serious adverse events from use of either therapy. This is a well-conducted trial that demonstrates that moxifloxacin 0.5% is as effective as combined fortified cefazolin and tobramycin in the treatment of moderate bacterial keratitis. With moxifloxacin 0.5% now being commercially available and non-preserved, it may now become a more popular treatment option for bacterial keratitis, although the threat of resistance developing does remain a concern.

Evaluation of moxifloxacin 0.5% in treatment of nonperforated bacterial corneal ulcers. A randomized controlled trial.
Sharma N, Goel M, Bansal S, et al.
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Brian Ang

Royal Victorian Eye and Ear Hospital, Melbourne, Australia

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