Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand.
College of Health, Massey University, Auckland, New Zealand.
Br J Ophthalmol. 2014 Nov;98(11):1470-7. doi: 10.1136/bjophthalmol-2013-304660. Epub 2014 Apr 12.
Severe bacterial keratitis (BK) typically requires intensive antimicrobial therapy. Empiric therapy is usually with a topical fluoroquinolone or fortified aminoglycoside-cephalosporin combination. Trials to date have not reached any consensus as to which antibiotic regimen most effectively treats BK.
A systematic review and meta-analysis using Cochrane methodology was undertaken to evaluate the effectiveness of topical antibiotics in the management of BK. Outcomes included treatment success, time to cure, serious complications of infection and adverse effects.
A comprehensive search for trials resulted in 27 956 abstracts for review. This eventually resulted in 16 high quality trials involving 1823 participants included in the review. Treatment success, time to cure and serious complications of infection were comparable among all antibiotic treatments included in the review. Furthermore, there was no evidence of difference in the risk of corneal perforation with any included antibiotics or antibiotic classes. Fluoroquinolones significantly reduced risk of ocular discomfort and chemical conjunctivitis but increased the risk of white precipitate formation compared with aminoglycoside-cephalosporin. Fortified tobramycin-cefazolin was approximately three times more likely to cause ocular discomfort than other topical antibiotics.
Results of this review suggest no evidence of difference in comparative effectiveness between fluoroquinolones and aminoglycoside-cephalosporin treatment options in the management of BK. There were differences in safety profile, however. Fluoroquinolones decreased the risk of ocular discomfort and chemical conjunctivitis while ciprofloxacin increased the risk of white corneal precipitate compared with aminoglycoside-cephalosporin.
严重细菌性角膜炎（BK）通常需要强化抗菌治疗。经验性治疗通常使用局部氟喹诺酮类药物或加用氨基糖苷类-头孢菌素联合治疗。迄今为止，尚无任何试验能就哪种抗生素方案最有效地治疗 BK 达成共识。
采用 Cochrane 方法进行系统评价和荟萃分析，以评估局部抗生素治疗 BK 的效果。结果包括治疗成功率、治愈时间、感染严重并发症和不良反应。
全面检索试验后，共审查了 27956 篇摘要。最终有 16 项高质量试验纳入了 1823 名参与者。所有纳入研究的抗生素治疗方法在治疗成功率、治愈时间和感染严重并发症方面均无差异。此外，任何纳入的抗生素或抗生素类别均未增加角膜穿孔的风险。与氨基糖苷类-头孢菌素相比，氟喹诺酮类药物显著降低了眼部不适和化学性结膜炎的风险，但增加了形成白色沉淀的风险。与其他局部抗生素相比，加用妥布霉素-头孢唑林的眼部不适风险大约增加了 3 倍。
本综述结果表明，在 BK 管理中，氟喹诺酮类药物与氨基糖苷类-头孢菌素治疗方案之间在疗效方面无差异，但安全性方面存在差异。与氨基糖苷类-头孢菌素相比，氟喹诺酮类药物降低了眼部不适和化学性结膜炎的风险，而环丙沙星增加了发生白色角膜沉淀的风险。
