|Year : 1988 | Volume
| Issue : 2 | Page : 95-97
Topical antibiotics in the management of corneal ulcer
P Ranga Reddy
Superintendent, S. D. Eye Hospital, Hyderabad, India
P Ranga Reddy
Superintendent, S. D. Eye Hospital, Hyderabad
Source of Support: None, Conflict of Interest: None
A total of 82 patients suffering from corneal ulcer were treated with framycetin 0.5%, gentamicin 3 mg./ml, chloramphenicol 0.4% and a neomycin combination containing Polymixin B sulphate 5000 u, neomycin sulphate 1700 u and gramicidin 0.025 mg/mL in a Randomised comparative study. The commonest organism isolated was Staphylococcus followed by Pneumococcus, Streptococcus and Pseudomonas. The in vitro sensitivity of these isolates to framycetin was higher than that to others Framycetin produced both earlier and a greater degree of improvement in mean score of signs and symptoms than the other antibiotics. It can thus be concluded that framycetin has a better profile of antibacterial activity and clinical efficacy than some other commonly used topical antibiotics in the treatment of corneal ulcer.
|How to cite this article:|
Reddy P R. Topical antibiotics in the management of corneal ulcer. Indian J Ophthalmol 1988;36:95-7
| Introduction|| |
Corneal ulcers constitute an important entity in ophthalmic practice. Control of infection, cleanliness, rest and protection are admittedly the fundamental principles in management of corneal ulcers. The first objective, viz control of infection, is achieved by the use of antibacterial agents. Of the drugs available in this category framycetin, gentamicin, chloramphenicol and neomycin combinations are extensively used in India The present study was designed to compare the efficacy and safety of these agents in the management of corneal ulcer.
| Material and Methods|| |
A total of 82 adult patients of either sex suffering from corneal ulcer were included in the study. A complete history was obtained for each patient and a thorough physical examination was performed both systemic and local.
The material from the infected site was collected on a sterile platinum loop or sterile swab and streaked on blood agar or chocolate agar. A smear was also made from the same material and stained with Grams stain Isolates obtained from the infected site were subjected to bacteriological examination using standard techniques and strains identified by their bacteriological, cultural and biochemical characteristics.' The isolates were also tested for antibiotic sensitivity to framycetin, gentamicin, chloramphenicol and neomycin by the disc diffusion method of Kirby and Bauer using Muller- Hinton medium and antibiotic sensitivity discs of standard strengths. , The local signs symptoms such as ciliary congestion, pain, lacrimation, foreign body sensation, exudation and so on were graded on a scale of 0 to 4 as follows :
Ciliary congestion : Limbal and perilimbal area divided into four zones. 1 - only one zone involved at a time. 2 - Two zones involved 3 - Three zones involved 4 - Four zones involved
Pain : 1 - Patient complains of pain but continues his usual day to day work. 2 - Patient not able to continue his day to day work but pain tolerable. 3 - Patient unable to tolerate pain but eye remains open 4 - Eye closed because of pain.
Lacrimation : 1 - Only medial canthus filled with tears. 2 - No overflow of tears over cheeks, tear comes out on opening the lower fomix 3 - Intermittent overflow of tears over cheeks. 4 - Continuous overflow of tears over cheeks.
Foreign body sensation : 1 - Patient complains of foreign body sensation, but continues his usual day to day work. 2 - Patient unable to continue his day to day work, but foreign body sensation tolerable. 3 - Patient unable to tolerate foreign body sensation but eye remains open 4 - Eye closed due to foreign body sensation
Exudation : I - Area of one zone involved 2 - Area of two zones involved 3 - Area of three zones involved 4 - Area of four zones involved
The selection criterion was essentially one of choosing moderate cases, viz a total mean score of signs and symptoms between the value of 2 and 3. Patients with mean values of less than 1 and greater than 3 were excluded.
General management such as saline wash, mydriatics such as atropine drops 1%, hot bathing or compresses and protective bandage, was started immediately. The antibiotic solution to be employed was chosen according to a randomised chart provided by a statistician The following strengths of antibiotic concentrations were used : framycetin sulphate 0.5%, gentamicin 3 mg/ml., chloramphenicol 0.4% and a neomycin combination containing polymixin B sulphate 5000 u, neomycin sulphate 1700 u and gramicidin 0.02 5 mg/ml. Systemic antimicrobial therapy consisted of cotrimoxazole 960 mg. twice a day for the duration of illness.
The local signs and symptoms were evaluated at each visit as above, and their progress with treatment noted. The overall response to treatment was graded on a scale of very good to poor as follows : Very Good =complete relief of symptoms by day 3; Good = complete relief by day 4 - 7; Fair = complete relief by day 7 - 14; Poor = complete relief > 14 days Side effects to treatment if any were noted. The clinical response to treatment was correlated with bacteriological findings
| Observations|| |
The age of the patients included in the study ranged between 10 and 60 years. The male : female ratio was 47 : 35.
[Table - 1] gives the bacteriological profile of patients treated for corneal ulcer. Staphylococcus was the most frequently encountered organism followed by Pneumococcus, Streptococcus and Pseudomonas, in that order. The percentage sensitivity of the various isolates ranged between 80 and 100 for framycetn, 51 and 100 for gentamicin, 20 and 64 for chloramphenicol and 20 and 86 for neomycin.
[Table - 2] gives the progress in the total mean score with treatment The mean pretreatment scores were comparable in all the groups From day2 onwards, all treatment groups showed a significant reduction in scores when compared to the pre- treatment values, but the reduction was more marked in the framycetin group.
[Table - 3] gives the overall clinical response to treatment with various antibiotics. Good to very good response was obtained in 91% of cases in the framycetin group, 77% with gentamicin, 56% with chloramphenicol and 61% with neomycin combination No side effects attributable to treatment were encountered in any of the groups.
| Discussion|| |
It is a common practice to employ topical antibiotics for the treatment of ocular infections Effective control of infection by an appropriate antibacterial agent can help prevent complications such as blindness following corneal ulcer. The criteria for choosing a topical antibiotic in ocular infections are, the susceptibility pattern of bacterial isolates and exclusive topical use since an antibiotic which is used systemically should not be used topically because of the risk of promoting both resistance and allergy to valuable systemic antibiotics ,. The present study has shown Staphylococcus to be the most frequently encountered pathogen from corneal ulcers. It is also evident that framycetin is more active than the other antibiotics studied against both Grampositive and Gram-negative isolates encountered in corneal ulcers This is also reflected in the rate and degree of improvement in the scores of clinical signs and symptoms following treatment with framycetin and other antibiotics.
It can thus be concluded that framycetin has a better profile of antibacterial activity and clinical efficacy than some other commonly used topical antibiotics in the treatment of corneal ulcer.
| References|| |
Cruickshank R Dugudi J. P., Marmion a P, et aL, Medical Microbiology, V. IL 12th ed, Churchill Livingstone, Edinburg London and New York, 1975.
Standard Disc Susceptibility Test Fed. Reg 37 (191), 20525, Sep. 30, 1972, and Amended Fed. Reg. 38, 2756, Jan. 30, 1973.
Acar J.F., Disc Susceptibility Tests In: Antibiotics in Laboratory Medicine, V. Lorian (ed), Williame & Willains, pp. 24-54, 1980.
Editorial Antibiotic resistance and topical treatment Br. Med. J., 11 : 649-650, 1978.
Antibiotics In: Ocular Pharmacology, Havener W. H, Fifth edition, The CV. Mosby Co., pp. 120-210, 1983.
[Table - 1], [Table - 2], [Table - 3]