Comparison of topical 0.3% ofloxacin with fortified tobramycin plus cefazolin in the treatment of bacterial keratitis

Abstract

Purpose Ofloxacin is a broad spectrum fluoroquinolone antibiotic with good ocular penetration. We compared ofloxacin 3% solution with a combination of fortified tobramycin sulphate and cefazolin sodium solutions in the treatment of culture-proven bacterial keratitis. Methods Thirty eyes with culture-proven bacterial corneal ulcers were enrolled in a prospective randomised, controlled, double-masked study for comparison. The ofloxacin drop and saline were decanted into two identical-looking bottles to the tobramycin and cefazolin. The cases were randomly allocated into treatment with 0.3% ofloxacin solution or a combination of fortified antibiotics (1.5% tobramycin and 10% cefazolin solutions; control group) along with supportive cycloplegic, vitamins and anti-glaucoma therapy. Student's t-test was used to compare the results. Results Staphylococcus aureus and coagulase-negative staphylococci were the two most common organisms isolated. Resolution of the ulcer was achieved in 93% and 87% of cases in the ofloxacin and control groups respectively. The mean time required for symptomatic relief was 7.8 ± 1.54 days and for epithelial healing 15.0 ± 3.86 days in ofloxacin group, compared with 8.33 ± 1.54 days for symptomatic relief and 15.46 ± 3.86 days for epithelial healing in the control group. Post-resolution best corrected visual acuity of 20/200 or better was achieved in all but one eye in both groups. Conclusions Ofloxacin and combined fortified tobramycin and cefazolin topical drops were comparable for treating cases of bacterial corneal ulcer. However, considering its easy availability and cost-effectiveness, monotherapy with ofloxacin is preferred over the combined fortified tobramycin and cefazolin therapy.