zithromax and Pain--Postoperative

After keratoplasty, antibiotic eye drops are used to prevent ocular infection until the recipient corneal epithelium has healed. We compared the effects of azithromycin, a new macrolide, with the effect of the standard antibiotics, tobramycin, on the (i) prevention of infection, (ii) epithelial healing, and (iii) ocular tolerance after penetrating keratoplasty.. In this prospective, single-center, randomized study, patients undergoing penetrating keratoplasty received postoperative topical dexamethasone and either azithromycin (n=23; Azyter(®); one drop twice daily for 3 days) or tobramycin (n=23; Tobrex(®); 1 drop 4 times daily until complete re-epithelialization). Daily slit-lamp examination with fluorescein was performed, and photographs were taken to digitally assess the re-epithelialized surface area. Daily questionnaires assessed ocular comfort and pain.. There were no cases of infection in either group. The re-epithelialized area of the corneal graft increased at a similar rate in each group, with no difference between the groups on any day. The mean±SD days until complete re-epithelialization did not differ between tobramycin (4.14±1.17) and azithromycin (4.13±1.82) (P=0.89). Superficial punctate keratitis scores were similar for tobramycin (1.39) and azithromycin (1.34). Pain and discomfort scores improved each day after surgery with no differences between the groups on any day.. Postkeratoplasty epithelial healing and ocular tolerance were not significantly different between the azithromycin- and tobramycin-treatment groups. Our results support the use of azithromycin as an alternative to tobramycin after corneal surgery such as keratoplasty.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Inflammatory Agents; Azithromycin; Cornea; Corneal Diseases; Dexamethasone; Epithelium, Corneal; Female; Humans; Keratitis; Keratoplasty, Penetrating; Male; Middle Aged; Ophthalmic Solutions; Pain, Postoperative; Postoperative Period; Prospective Studies; Surgical Wound Infection; Tobramycin; Wound Healing; Young Adult

Combined treatments with non-steroidal anti-inflammatory drugs and antibiotics may offer significant benefits in the prevention of pain and infections associated with oral surgery. In this study, piroxicam and azithromycin were administered to patients undergoing dental extraction to examine the efficacy of piroxicam in the prevention of post-operative pain and inflammatory complications, either in the absence or in the presence of a concomitant antibiotic treatment. Thirty patients were randomly assigned to three groups and treated for 3 days, before impacted lower third molar removal, as follows: (1) sublingual piroxicam-FDDF (fast dissolving dosage formulation) 20 mg/day; (2) oral azithromycin 500 mg/day; (3) piroxicam-FDDF 20 mg/day plus azithromycin 500 mg/day. Oral acetaminophen (500 mg tablets) was allowed as rescue analgesic medication. Pain intensity was evaluated on a 100-mm visual-analogue scale after dental extraction (day 1), and at days 2, 3, 7 after surgery. Edema and trismus were estimated at days 2 and 7. At days 1 and 2, pain intensity was significantly lower in patients treated with piroxicam-FDDF, either alone (p < 0.05) or in combination with azithromycin (p < 0.05), than in patients administered with azithromycin alone. A higher acetaminophen consumption was also recorded in the latter group (p < 0.01). Pain intensity values did not differ among treatment groups at days 3 and 7. At day 2, the facial edema was significantly less intense in patients exposed to piroxicam-FDDF alone, as compared to patients treated with azithromycin, either alone (p < 0.05) or in combination with piroxicam-FDDF (p < 0.05). No significant differences were detected when comparing groups for trismus at days 2 and 7. The present results indicate that, when given alone in the pre-operative period, piroxicam-FDDF effectively counteracts post-surgical pain and inflammatory reactions in oral tissues. Upon combined treatment with piroxicam-FDDF and azithromycin, the macrolide antibiotic may reduce the influence of piroxicam on post-operative inflammation, without affecting its beneficial effect on surgical pain.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Azithromycin; Drug Therapy, Combination; Edema; Female; Humans; Male; Molar, Third; Pain, Postoperative; Piroxicam; Postoperative Complications; Tooth Extraction; Tooth, Impacted; Trismus