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A Single-Blinded Randomized Clinical Trial Comparing Polymyxin B-Trimethoprim and Moxifloxacin for Treatment of Acute Conjunctivitis in Children - 25/03/13

Doi : 10.1016/j.jpeds.2012.09.013 
Lee Williams, DO 1, , Yogangi Malhotra, MD 1, 5, , Barbra Murante, NP 1, Susan Laverty, RN 1, Steve Cook, MD 1, David Topa, MD 1, 2, Dwight Hardy, PhD 3, Hongyue Wang, PhD 4, Francis Gigliotti, MD 1, 3,
1 Department of Pediatrics, Golisano Children’s Hospital at Strong, University of Rochester School of Medicine and Dentistry, Rochester, NY 
2 Pittsford Pediatrics, Pittsford, NY 
3 Department of Microbiology and Immunology, Strong Memorial Hospital, University of Rochester School of Medicine and Dentistry, Rochester, NY 
4 Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY 
5 Division of Neonatology, Department of Pediatrics, Maria Fareri Children’s Hospital at Westchester Medical Center, Valhalla, NY 

Reprint requests: Francis Gigliotti, MD, Department of Pediatrics, Golisano Children’s Hospital at Strong, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 690, Rochester, NY 14642.

Abstract

Objective

To perform a randomized controlled trial comparing moxifloxacin hydrochloride with polymyxin B-trimethoprim for the treatment of acute conjunctivitis.

Study design

Patients ages 1-18 years old with acute conjunctivitis had cultures performed and were randomized to receive either moxifloxacin hydrochloride or polymyxin B-trimethoprim ophthalmic solution for 7 days. Response to treatment was determined by phone query on day 4-6 and by examination with post-treatment conjunctival culture on day 7-10.

Results

One hundred and twenty-four patients were enrolled. Eighty patients (65%) had recognized pathogens (55 Haemophilus influenzae, 22 Streptococcus pneumoniae, 4 Moraxella catarrhalis) isolated from their conjunctiva. One hundred fourteen (56/62 moxifloxacin and 58/62 polymyxin B-trimethoprim) completed the 4-6 day evaluation, with 43/56 (77%) of the moxifloxacin group and 42/58 (72%) of the polymyxin B-trimethoprim group clinically cured according to parents (noninferiority test P = .04). Eighty-nine (39/56 moxifloxacin and 50/58 polymyxin B-trimethoprim) patients completed the 7-10 day evaluation. Clinical cure was observed in 37/39 (95%) of the moxifloxacin and 49/51 (96%) of the polymyxin B-trimethoprim treated groups (noninferiority test P ≤ .01). Clinical cure rates for culture positive and negative conjunctivitis were not different. There was no statistically significant difference in bacteriologic cure rates between the 2 groups.

Conclusions

Polymyxin B-trimethoprim continues to be an effective treatment for acute conjunctivitis with a clinical response rate that does not differ from moxifloxacin. Use of polymyxin B-trimethoprim for the treatment of conjunctivitis would result in significant cost savings compared with fluoroquinolones.

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Keyword : MIC


Mappa


 Y.M. is supported in part by a resident research grant from the American Academy of Pediatrics. The authors declare no conflicts of interest.


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