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George John; A Comparative Study in the Clinical and Microbial Efficacy of Topical Besifloxocin Ophthalmic Suspension 0.6% with Erythromycin Ophthalmic Ointment 0.5% for Management of Acute Blepharitis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6263.
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To evaluate the relative efficacy of Besifloxocin and Erythromycin in the management of symptomatic acute blepharitis. Specifically, the clinical response in terms of graded signs and symptoms as well as the microbiology and bacterial eradication rates using these two antibiotics to treat blepharitis were studied.
Thirty patients with symptomatic anterior blepharitis, as documented by eyelash crusting along with other signs of lid inflammation, were randomized to receive either topical Besifloxocin 0.6% or Erythromycin 0.5%, bid along with standard lid hygiene measures. This was an open label, unmasked comparison and all patients were graded using a scoring system for signs and symptoms of blepharitis over a period of four weeks. Cultures and sensitivities to a panel of antibiotics were obtained at the first visit prior to starting therapy and again after two weeks of therapy.
All patients demonstrated similar improvement in both groups based on scored symptoms of common blepharitis complaints as well as a grading of conjunctival, lid and corneal findings. Mean subjective scores improved from 7.60 to 3.53 in the Besifloxocin (B) group as compared to 7.26 and 3.13 in the Erythromycin (E) group. Average scoring of conjunctival injection improved as follows: 1.20 to 1.07 (B), 1.27 to 1.00 (E). Lid inflammation scores improved as follows: 4.73 to 3.00 (B), 4.27 to 2.67 (E). Average corneal staining improved from 0.60 to 0.47 (B) and 1.13 to 0.60 (E). Rosacea was a known diagnosis in 5/15 patients in each group.The largest notable difference was in the cultures post-treatment with 6/13 showing no growth in the Besifloxocin group and 0/15 in the Erythromycin group. Of particular note was the fact that 7/15 cultures in the Erythromycin group showed either increased growth of coagulase negative staphylococcus or growth of new organisms.
All patients treated with standardized lid hygiene measures and a topical antibiotic demonstrated similar rates of improvement in terms of signs and symptoms of acute blepharitis. Based on culture results, Besifloxocin was able to eliminate organisms in all cases with the exception of light growth of the skin organism coagulase negative staphylococcus in some cases. Erythromycin treated patient’s demonstrated overgrowth of coagulase negative staphylococcus or new growth of other organisms. Overall, cultures of patients with symptomatic anterior blepharitis were positive in 16/30 patients in this study with 6/16 demonstrating resistance to erythromycin and ciprofloxacin.
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