Abstract
Abstract: :
Purpose:To assess the relative comfort and tolerability of ciprofloxacin HCL 0.3% ophthalmic solution (Ciloxan® - Alcon), trimethoprim sulfate/polymyxin B sulfate ophthalmic solution (Polytrim® - Allergan), and gentamicin sulfate ophthalmic solution in a pediatric population. Methods:A randomized, double-masked, crossover study in normal pediatric patients between the ages of 7 and 17. At baseline (hour 0) all qualifying patients were administered 1 drop of a tear substitute in each eye. At time 1, 2 and 3 hours patients received 1 drop in each eye of ciprofloxacin, trimethoprim/polymyxin B and gentamicin in a randomly assigned order. Patients evaluated the comfort of each drop immediately after instillation using an annotated scale ranging from «0’ indicating «no drop awareness» to «10’ indicating «intolerable, redness, and blepharospasms .» Results:All 25 patients enrolled completed the study. Mean comfort score for placebo was 0.76 increasing to 1.86, 1.54, and 1.12 for, ciprofloxacin, trimethoprim/polymyxin B and gentamicin, respectively. No clinically or statistically significant differences in mean comfort were found between these three antibiotics in this pediatric population. Comfort for ciprofloxacin, trimethoprim /polymyxin B and gentamicin, were all rated with mean comfort scores <2, categorized as «drop awareness but comfortable.» Conclusion:Ciprofloxacin provides a concentration-dependent bactericidal action at lower minimum inhibitory concentrations (MIC90) than trimethoprim/polymyxin B and gentamicin for Streptococcus pneumoniae (1.0 µg/ml, 16.0 µg/ml, and 16.0 µg/ml respectively) and Haemophilus influenzae (0.06 µg/ml, 1.0 µg/ml, and 4.0 µg/ml respectively) 1 which are two of the more common causative bacteria in children , . Additionally, ciprofloxacin provides lower MIC90 compared with gentamicin for Staphylococcus aureus (methicillin susceptible (ms)) (0.25 µg/ml and 16.0 µg/ml respectively), Staphylococcus epidermis (ms) (4.0 µg/ml and 32.0 µg/ml respectively), and Psuedomonas aeruginosa (0.25 and 2.0 µg/ml respectively)1. Due to its broad range of coverage, lower MICs, and patient reported comfort, ciprofloxacin may be the primary choice for treating bacterial conjunctivitis in pediatric patients compared with trimethoprim/polymyxin B and gentamicin.
Keywords: 319 antibiotics/antifungals/antiparasitics • 366 conjunctivitis