The Fluoroquinolone Toxicity Research Foundation

 
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Br J Ophthalmol 2000;84:378-384.

Fluoroquinolone Effective In Treating Corneal Ulcer But Should Be Used With
Caution
May 4, 2000
WESTPORT (Reuters Health) - Fluoroquinolone drops and combined fortified
antibiotics are equally effective in treating bacterial corneal ulcer.
However, although fluoroquinolone therapy is shorter, it leads to more
serious complications and should be used with caution, particularly in the
elderly, Australian researchers report in the April issue of the British
Journal of Ophthalmology.


Dr. Mark Daniell and colleagues, from the University of Melbourne, reviewed
the medical records of 138 patients with bacterial corneal ulcer. Of these,
54 were treated with fluoroquinolone and 84 were treated with tobramycin
1.3% plus cefazolin 5%.

The two therapies were equally effective in treating the condition in terms
of visual outcome, the researchers found. However, serious complications
such as corneal perforation, evisceration, or enucleation of the affected
eye occurred in 16.7% of patients receiving fluoroquinolone, compared with
only 2.4% of patients receiving fortified antibiotic therapy. The authors
estimated that patients taking fluoroquinolone had an 8.9-fold increased
risk of serious complications.

Compared with fortified antibiotics, in patients over 60 years of age,
fluoroquinolone therapy significantly reduced the length of intensive
therapy, from 6 days to 4 days, and significantly reduced median hospital
stay, from 10 days to 7 days. Dr. Daniell's group suggests that this could
result from "quicker clinical response of healing as a result of less
toxicity found in the patients treated with fluoroquinolone."

Corneal perforation may have been the result of coexisting ocular
pathologies, or fluoroquinolone may have altered the tectonic strength of
the cornea, the authors write. In elderly patients with deep ulcers, they
recommend that "use of combined fortified antibiotics rather than
fluoroquinolones could be considered in cases at higher risk of
perforation."

Br J Ophthalmol 2000;84:378-384.