0.3%环丙沙星和0.3%氧氟沙星局部应用时轻度、中度和重度细菌性角膜溃疡的分类及首日治疗方案综述
A Review of the Categorizations of Mild, Moderate, and Severe Bacterial Keratitis Ulcers and Day-1 Treatment Regimen When Using the Topical Fluoroquinolones 0.3% Ciprofloxacin and 0.3% Ofloxacin.
作者信息
Pearce John Graham, Sarac Ozge, Maddess Ted
机构信息
John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia.
Department of Ophthalmology, Ankara Yildirim Beyazit University, Ankara, Turkey.
出版信息
Curr Ther Res Clin Exp. 2023 Nov 17;99:100729. doi: 10.1016/j.curtheres.2023.100729. eCollection 2023.
BACKGROUND
There are published suggestions that bacterial keratitis (BK) can be classified as mild, moderate, or severe and that the day-1 antibiotic drop regimen may differ for each category using the topical second-generation fluoroquinolones 0.3% ciprofloxacin and 0.3% ofloxacin (2FQ). The classification criteria are not consistently defined and the suggested regimens are often unreferenced and so here, the evidence base for applying such regimens in clinical practice is examined.
OBJECTIVE
To examine the evidence base regarding the categorization criteria used for BK and determine whether any evidence exists to support suggestions that different day-1 treatment regimen using the 2FQ may be applied based on any assigned categorization.
METHODS
The literature on BK treatment was reviewed, as were the clinical studies involving the commercially available 2FQ. All statements pertaining to classification and treatment paradigms involving BK were then collated and reviewed, as were the methodologies employed in the 2FQ clinical studies.
RESULTS
There have been no clinical trials using the 2FQ, or indeed any other topical antibiotics, which have used different day-1 drop regimen depending on the size, depth, and location of the ulcer or for ulcers classified as mild, moderate, or severe. Thus, there is no evidence to support the suggestion that a lower number of drops on day 1 is as effective as a higher number on categorized BK ulcers.
CONCLUSIONS
No standardized method of categorizing BK was found, and there is no evidence to support the contention that mild, moderate, or smaller BK ulcers should be treated any differently to larger or severe ulcers on day 1. The manufacturers of 2FQ do not supply different treatment regimens for different ulcer sizes and severity categories. When using the 2FQ, all BK ulcers should be treated equally in line with the manufacturers' recommended day-1 treatment regimen.
背景
有已发表的建议称，细菌性角膜炎（BK）可分为轻度、中度或重度，且使用0.3%环丙沙星和0.3%氧氟沙星这两种局部用第二代氟喹诺酮类药物（2FQ）时，不同分类的第1天抗生素滴眼方案可能有所不同。分类标准并未得到一致界定，且所建议的方案往往未注明参考文献，因此在此对在临床实践中应用此类方案的证据基础进行研究。
目的
研究关于BK分类标准的证据基础，并确定是否有证据支持基于任何指定分类应用不同的第1天2FQ治疗方案的建议。
方法
回顾了关于BK治疗的文献以及涉及市售2FQ的临床研究。然后整理并审查了所有与BK分类和治疗模式相关的陈述，以及2FQ临床研究中所采用的方法。
结果
尚无使用2FQ或实际上任何其他局部用抗生素的临床试验，根据溃疡的大小、深度和位置或根据溃疡分类为轻度、中度或重度而采用不同的第1天滴眼方案。因此，没有证据支持第1天滴眼次数较少与分类后的BK溃疡滴眼次数较多效果相同的建议。
结论
未发现对BK进行分类的标准化方法，且没有证据支持以下观点，即轻度、中度或较小的BK溃疡在第1天的治疗应与较大或重度溃疡有所不同。2FQ的制造商并未针对不同的溃疡大小和严重程度类别提供不同的治疗方案。使用2FQ时，所有BK溃疡均应按照制造商推荐的第1天治疗方案进行同等治疗。
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