Early addition of topical corticosteroids in the treatment of bacterial keratitis.

Abstract

IMPORTANCE:

Scarring from bacterial keratitis remains a leading cause of visual loss.

OBJECTIVE:

To determine whether topical corticosteroids are beneficial as an adjunctive therapy for bacterial keratitis if given early in the course of infection.

DESIGN, SETTING, AND PARTICIPANTS:

The Steroids for Corneal Ulcers Trial (SCUT) was a randomized, double-masked, placebo-controlled trial that overall found no effect of adding topical corticosteroids to topical moxifloxacin hydrochloride in bacterial keratitis. Here, we assess the timing of administration of corticosteroids in a subgroup analysis of the SCUT. We define earlier administration of corticosteroids (vs placebo) as addition after 2 to 3 days of topical antibiotics and later as addition after 4 or more days of topical antibiotics.

MAIN OUTCOMES AND MEASURES:

We assess the effect of topical corticosteroids (vs placebo) on 3-month best spectacle-corrected visual acuity in patients who received corticosteroids or placebo earlier vs later. Further analyses were performed for subgroups of patients with non-Nocardia keratitis and those with no topical antibiotic use before enrollment.

RESULTS:

Patients treated with topical corticosteroids as adjunctive therapy within 2 to 3 days of antibiotic therapy had approximately 1-line better visual acuity at 3 months than did those given placebo (-0.11 logMAR; 95% CI, -0.20 to -0.02 logMAR; P = .01). In patients who had 4 or more days of antibiotic therapy before corticosteroid treatment, the effect was not significant; patients given corticosteroids had 1-line worse visual acuity at 3 months compared with those in the placebo group (0.10 logMAR; 95% CI, -0.02 to 0.23 logMAR; P = .14). Patients with non-Nocardia keratitis and those having no topical antibiotic use before the SCUT enrollment showed significant improvement in best spectacle-corrected visual acuity at 3 months if corticosteroids were administered earlier rather than later.

CONCLUSIONS AND RELEVANCE:

There may be a benefit with adjunctive topical corticosteroids if application occurs earlier in the course of bacterial corneal ulcers.

• Authors: Kathryn J Ray, Muthiah Srinivasan, Jeena Mascarenhas, Revathi Rajaraman, Meenakshi Ravindran, David V Glidden, Catherine E Oldenburg, Catherine Q Sun, Michael E Zegans, Stephen D McLeod, Nisha R Acharya, Thomas M Lietman
• Journal: JAMA ophthalmology (JAMA Ophthalmol) Vol. 132 Issue 6 Pg. 737-41 (Jun 2014) ISSN: 2168-6173 [Electronic] United States
• PMID: 24763755 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Aza Compounds
• Fluoroquinolones
• Quinolines
• Prednisolone
• Moxifloxacin

Topics

• Administration, Topical
• Adult
• Aza Compounds (administration & dosage)
• Confidence Intervals
• Dose-Response Relationship, Drug
• Double-Blind Method
• Drug Administration Schedule
• Drug Therapy, Combination
• Eye Infections, Bacterial (diagnosis, drug therapy)
• Female
• Fluoroquinolones
• Follow-Up Studies
• Humans
• Keratitis (drug therapy, microbiology)
• Linear Models
• Male
• Middle Aged
• Moxifloxacin
• Multivariate Analysis
• Prednisolone (administration & dosage)
• Quinolines (administration & dosage)
• Severity of Illness Index
• Time Factors
• Treatment Outcome