gramicidin-a and Postoperative-Complications

The presented pilot study compared the effectiveness of combined antibiotic ophthalmic solution (neomycin sulfate, polymyxin B sulfate and gramicidin) with a placebo (artificial tear) in the treatment of hordeolum after incision and curettage (I&C). A randomized, placebo-controlled trial with patients and investigators blinded from the start started from June 2002 to May 2003. Subjects were patients with untreated hordeolum who subsequently underwent I&C at the Ophthalmology Department. The patients were randomized into 2 groups: group A for combined antibiotic ophthalmic solution, and group B for artificial tear containing the antibiotic solution base. Pain score, mass size and duration of cure were recorded before and on the 3rd and 7th day after treatment. The study included 14 patients in each group. Two subjects in group A and three subjects in group B dropped out. There were no statistically significant differences of all outcomes in both groups, even with the intention-to-treat analysis. The conclusion is combined antibiotic ophthalmic solution is not more effective than placebo in the treatment of hordeolum after I&C.

Topics: Anti-Bacterial Agents; Double-Blind Method; Drug Combinations; Gramicidin; Hordeolum; Humans; Neomycin; Ophthalmic Solutions; Ophthalmologic Surgical Procedures; Pilot Projects; Polymyxin B; Postoperative Complications

Intraocular inflammation is typically treated with a combination of anti-inflammatory and anti-infective drugs. Tobramycin-dexamethasone (TD) has not been associated with any serious adverse events, indicating good tolerability.. The aims of this study were the following: (1) to demonstrate noninferiority of TD compared with dexamethasone-neomycin-polymyxin (DNP) in terms of anti-inflammatory efficacy, (2) to compare the anti-inflammatory efficacy of TD and DNP with that of a "placebo" control (antibiotic without anti-inflammatory agent), and (3) to provide additional safety data on TD.. This prospective, double-masked, parallel-group study was conducted at 22 ophthalmology clinics across Europe and Brazil. Patients aged > 18 years undergoing cataract surgery were randomly assigned, in a 2:2:1 ratio, to receive tobramycin 3 mg/mL plus dexamethasone 1 mg/mL, dexamethasone 1 mg/mL plus neomycin sulfate 3500 IU/mL plus polymyxin B sulfate 6000 IU/mL, or neomycin sulfate 3500 IU/mL plus polymyxin B sulfate 7500 IU/mL plus gramicidin 20 microg/mL. All treatments were given as 1 drop instilled in the operated eye q.i.d. for 21 days. The primary efficacy end point, intraocular inflammation (determined using the sum of scores on anterior chamber cells and aqueous flare), was assessed at days 3, 8, 14, and 21 after surgery.. A total of 271 patients were enrolled (158 women, 113 men; age range 42-90 years) (TD, 104 patients; DNP, 110 patients; and neomycin-polymyxin-gramicidin [NPG], 57 patients). Intraocular inflammation was similar in the TD and DNP groups at all time points. At days 8, 14, and 21, inflammation scores were significantly lower with TD than with NPG (all, P < 0.05). At day 8, the inflammation score was significantly lower with DNP than with NPG (P < 0.05). A greater number of patients receiving NPG experienced treatment-related ocular allergic reactions compared with patients receiving TD (P < 0.05). One patient receiving TD (1.0%) and 5 given NPG (9.0%) were withdrawn due to ocular allergic reactions. None of the patients experienced an increase in intraocular pressure > or =10 mm Hg from baseline.. In this study of patients undergoing cataract surgery combination therapy with TD was noninferior to DNP and was well tolerated.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Inflammatory Agents; Brazil; Cataract Extraction; Dexamethasone; Double-Blind Method; Drug Therapy, Combination; Europe; Female; Gramicidin; Humans; Inflammation; Male; Middle Aged; Neomycin; Polymyxins; Postoperative Complications; Prospective Studies; Tobramycin; Treatment Outcome

Around 11-12% of tympanostomy tubes are reported to become blocked by middle ear secretions or blood immediately following surgery, and so no longer function. Many otologists routinely instil an antibiotic and steroid-containing solution at the time of surgery in the belief that this may reduce this complication. The aim of the study was to investigate the efficacy of instilling the antibiotic and steroid-containing solution Sofradex at the time of grommet insertion in preventing grommet blockage. Double-blind randomized-controlled trial, comparing rates of grommet blockage in ears treated with Sofradex drops against control (no drops) in patients undergoing bilateral grommet insertion. Sixty-one pairs of results were obtained. There was a significant difference between the rates of grommet blockage in the two groups. Grommets with Sofradex drops instilled perioperatively were nine times less likely to be blocked than controls [1.6%versus 13.1%, odds ratio (Sofradex/control) = 9.06, 95% confidence interval (CI): 1.04-78.82, P = 0.05]. There was no association between grommet blockage and perioperative bleeding or the nature and presence of middle ear secretions. Sofradex eardrops are effective in reducing the rate of grommet blockage when instilled perioperatively.

Topics: Administration, Topical; Anti-Infective Agents; Child, Preschool; Dexamethasone; Double-Blind Method; Drug Combinations; Female; Follow-Up Studies; Framycetin; Gramicidin; Humans; Intraoperative Care; Male; Middle Ear Ventilation; Postoperative Complications; Prospective Studies

Topics: Bone Transplantation; Cholesteatoma, Middle Ear; Dexamethasone; Drug Combinations; Framycetin; Gramicidin; Hearing Loss, Sensorineural; Humans; Mastoid; Postoperative Complications; Retrospective Studies; Transplantation, Autologous

Most germs causing postoperative endophthalmitis derive from the conjunctival bacterial normal flora. Postoperative endophthalmitis is often induced by staphylococcal germs. The application of polyvidone-iodine solution to the conjunctiva is one possibility to reduce potential endophthalmitis-causing bacteria. The aim of this study was to evaluate the effectiveness of 1% polyvidone-iodine solution concerning the reduction of colonization with staphylococci in the course of intraocular surgery. This is to evaluate the effectiveness of 1% polyvidone-iodine solution concerning coagulase-negative and positive staphylococci.. Patients with intrabulbar surgery (300) had three conjunctival swabs taken: the first immediately prior to preoperative preparation in the operating theatre, following in-patient application of antibiotic eye drops (Polymyxin-B-sulfat, Neomycinsulfat and Gramicidin in combination); the second swab was taken after antisepsis with polyvidone-iodine before opening the conjunctiva. At the end of surgery the third smear was taken.. In 30.3% staphylococci were isolated from eyes before disinfection. Some patients (7.7%) were staphylococci-positive after disinfection; 5.3% of the patients showed staphylococcal growth at the end of surgery. To evaluate the effectiveness of polyvidone-iodine 1% solution we compared the first and the second smear (Mc Nemar). We found a statistically significant reduction (P < 0.001). At the end of surgery the conjunctival colonization with staphylococcal germs remained statistically significant reduced (P < 0.001). The mean operation time was 37 +/- 24 min.. We concluded that a significant reduction of a staphylococcal colonization can be achieved by preoperative application of polyvidone-iodine (1%) (P < 0.001). Even at the end of surgery the effect of 1% polyvidone-iodine solution held.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Conjunctiva; Drug Therapy, Combination; Endophthalmitis; Gramicidin; Humans; Neomycin; Ophthalmic Solutions; Ophthalmologic Surgical Procedures; Polymyxin B; Postoperative Complications; Povidone-Iodine; Premedication; Retrospective Studies; Solutions; Staphylococcus

Topics: Animals; Anterior Chamber; Atropine; Cornea; Disease Models, Animal; Gramicidin; Inflammation; Male; Methods; Neomycin; Nylons; Phenylephrine; Polymyxins; Postoperative Care; Postoperative Complications; Rabbits; Suture Techniques; Sutures; Textiles; Wound Healing