Moxifloxacin versus Combination Therapy (Tobramycin + Cefazolin) In Bacterial Keratitis – A Randomized Controlled Trial

Abstract

Background and Objectives Increasing resistance of bacterial keratitis isolates has been shown against second generation fluoroquinolones. Moxifloxacin and Gatifloxacin, are fourth generation FQs, which have been introduced recently. These new ocular antibiotic formulations have improved potency and have been shown to inhibit growth of organisms resistant to second and third generation FQs. Hence the present randomized controlled trial was undertaken to compare the effectiveness of moxifloxacin monotherapy with combination therapy for the treatment of bacterial keratitis. Methods The present one year randomized controlled trial was conducted in the Department of Ophthalmology, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum during the period of January 2010 to December 2010 on 60 patients diagnosed with bacterial keratitis. Patients were randomly allocated into two treatment groups using computer generated randomization Group A (n=30; received monotherapy with Moxifloxacin ) and Group B (n=30; received combination therapy with Tobramycin and Cefazolin ). After corneal scrapings was obtained assigned study medication was instilled and antibiotics were tapered as per the response. Results In this study 37 (61.67%), male predominance was seen with male to female ratio of 1.61:1. Mean age in Group A was 54.37 ± 15.65 years and in VIII Group B it was 56.37 ± 10.83 years. Positive bacterial culture was obtained in 68.33% cases and distribution of organisms was similar in both groups. There was no statistical difference in the final outcome between the two groups (Group A 96.67%; Group B 90%.; p=0.3006). The mean duration of healing in group A was significantly less (2.03±0.54 v/s 2.31±0.41; p= 0.032). Patients in group B had significantly more severe adverse effects (p= 0.0384). Conclusion and interpretation Patients treated with moxifloxacin had shown significantly better results in terms of lesser duration of healing and no adverse effects as compared with fortified antibiotics