gramicidin-a and Conjunctivitis--Bacterial

To report the efficacy of povidone-iodine as a treatment for conjunctivitis in pediatric patients.. Double-masked, controlled, prospective clinical trial.. In an ophthalmology clinic in a general hospital in Manila, Philippines, 459 children (mean [SD] age 6.6 [6.6] years; range, 7 months-21 years) with acute conjunctivitis were studied. Infected eyes were cultured for bacteria and underwent immunofluorescent testing for Chlamydia trachomatis. Viral conjunctivitis was diagnosed if bacterial cultures were negative and diagnostic criteria were met. Subjects were alternated to receive povidone-iodine 1.25% or neomycin-polymyxin-B-gramicidin ophthalmic solution, one drop 4 times daily in the affected eye. Ocular inflammation was evaluated daily by the family or patient and weekly by an ophthalmologist. The main outcome measures were days until cured and proportion cured after 1 and 2 weeks of treatment.. Despite adequate statistical power (power >80% for a 1-day difference and P <.05), there was no significant difference between treatment groups regarding the number of days to cure or proportion cured at 1 or 2 weeks whether caused by bacteria or virus (P =.133-.824 for the four comparisons). After 1 week of treatment, povidone-iodine cured marginally more chlamydial infections than the antibiotic (P =.057). By 2 weeks, fewer chlamydial infections were cured than those of viral or bacterial etiology (P =.0001). The younger the patient, the faster their conjunctivitis resolved (R = 0.13, P =.013).. Povidone-iodine 1.25% ophthalmic solution was as effective as neomycin-polymyxin B-gramicidin for treating bacterial conjunctivitis, somewhat more effective against chlamydia, and as ineffective against viral conjunctivitis. Povidone-iodine ophthalmic solution should be strongly considered as treatment for bacterial and chlamydial conjunctivitis, especially in developing countries where topical antibiotics are often unavailable or costly.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacteria; Child; Child, Preschool; Conjunctiva; Conjunctivitis, Bacterial; Conjunctivitis, Viral; Double-Blind Method; Drug Therapy, Combination; Female; Gramicidin; Humans; Infant; Male; Neomycin; Ophthalmic Solutions; Polymyxin B; Povidone-Iodine; Prospective Studies; Treatment Outcome; Viruses

A safety and efficacy study comparing the clinical and bacteriologic effectiveness of trimethoprim-sulfacetamide-polymyxin B-neomycin-gramicidin in a group of patients with surface ocular bacterial infections was conducted. The results demonstrated TSP to be as effective as the other solution (both clinically and bacteriologically), with fewer adverse experiences. A second study was conducted comparing TSP with trimethoprim-polymyxin B (TP) and found TP to be superior to TSP in effecting bacteriologic cures. Clinical response was similar in both groups, and the low incidence of mild adverse experiences was approximately the same. It appears that the combination of trimethoprim with polymyxin B is safe and highly efficacious, both clinically and microbiologically, for the treatment of surface ocular bacterial infections.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Blepharitis; Child; Conjunctivitis, Bacterial; Double-Blind Method; Drug Therapy, Combination; Eyelid Diseases; Female; Gramicidin; Humans; Male; Middle Aged; Neomycin; Ophthalmic Solutions; Polymyxin B; Polymyxins; Sulfacetamide; Trimethoprim

Neisseria meningitidis is an uncommon cause of acute bacterial conjunctivitis. One case of primary meningococcal conjunctivitis in a healthy 6-year-old boy is reported. The patient was initially treated with a topical instillation of polymyxin B, neomycin and gramicidin in ophthalmic solution, and this was followed by systemic rifampin once the diagnosis had been established. No ocular or systemic complications developed.

Topics: Administration, Oral; Administration, Topical; Anti-Bacterial Agents; Child; Conjunctivitis, Bacterial; Gramicidin; Humans; Male; Meningococcal Infections; Neisseria meningitidis; Neomycin; Polymyxin B; Rifampin