Abstract
Purpose :
To compare the efficacy of monotherapy with ofloxacin 0.3% versus combination therapy with cephalothin 5% and gentamicin 0.9% in the treatment of bacterial keratitis.
Methods :
A retrospective cohort study included all patients with a positive bacterial corneal scrape and treated with either combination therapy with cephalothin 5% and gentamicin 0.9% or monotherapy ofloxacin 0.3%, between January 2012 to December 2016 at the Sydney Eye Hospital, Australia. Cases were identified from pathology results and ICD-10 coding. Data were collected from medical records. Visual acuity (VA) was recorded and converted from Snellen to logarithm of the minimum angle of resolution (logMAR). The clinical and microbiological profiles and patient outcome were evaluated.
Results :
443 cases of 424 patients were included. 280 cases were treated with combination fortified antibiotics (fortified) and 163 were treated with monotherapy ofloxacin (monotherapy). Median age and females included were 67 years (IQR 45-82) and 53% in fortified and 40 years (IQR 29-52) and 48% in monotherapy (p <0.001 and p=0.413, respectively). A total of 553 organisms were identified, the main causative organisms were Coagulase-negative Staphylococcus (n=255, 46%), Pseudomonas aeruginosa (n=76, 14%), and Staphylococcus aureus (n=53, 10%). Fortified had worse clinical features at baseline than monotherapy; initial visual acuity (1.7 vs 0.4, p<0.001), epithelial defect size (5.34 vs 1mm2, p<0.001) and presence of hypopyon (31% vs 6%, p<0.001). At final visit, although the change in VA was insignificant amongst both groups (p=0.219), monotherapy had better outcomes than fortified with days of admission (8 vs 5 days, p=0.007), healing time (12 vs 7 days, p=0.001) and patient outcomes (good 17% vs 46%, p<0.001).
Conclusions :
Monotherapy with ofloxacin 0.3% led to shorter duration of hospital stay and healing time, and better patient outcomes than combination fortified antibiotics. However, patients on monotherapy with ofloxacin 0.3% had less severe keratitis at baseline visit than combination fortified antibiotics.
This is a 2020 ARVO Annual Meeting abstract.