Acute Bacterial Conjunctivitis Research Articles

Results of a survey of children with acute bacterial conjunctivitis treated with trimethoprim-polymyxin B ophthalmic solution

Acute conjunctivistis, one of the most frequently seen eye diseases in infants and children, is associated with a shorter duration of clinical disease when antimicrobial agents are used. Although viruses often are implicated as causative agents, Haemophilus influenzae and Streptococcus pneumoniae are the most commonly isolated bacterial pathogens. Empiric theraphy of acute conjunctivitis therefore should include agents with both gram-positive and gram-negative antimicrobial activity. Trimethoprim-polymyxin B is a broad-spectrum antimicrobial agent available as an ophthalmic solution. We conducted a patient outcomes study to evaluate the subjective response to treatment with trimethoprim-polymyxin B of children with presumed acute bacterial conjunctivitis. Questionnaires were distributed to more than 100 pediatricians who assessed outcome measures in 472 children with acute bacterial conjunctivitis for whom they prescribed trimethoprimpolymyxin B. The parameters evaluated were clinical outcome, overall, efficacy, and comfort provided by the medication regimen. The physicians reported that 95% of the infected eyes were cured or improved within 7 days. In addition, the overall efficacy of trimethoprim-polymyxin B was rated as excellent or good in 76% and 20% of cases, respectively. With regard to patient comfort, patients or their caregivers reported that patients were very comfortable or moderately comfortable in 62% and 27% of cases, respectively. Four adverse events were reported; all were transient and of mild-to-moderate intensity. The survey results support clinical research findings on the comparative efficacy and safety of trimethoprimpolymyxin B ophthalmic solution compared with other ophthalmic antimicrobial agents. The pediatricians in our survey who prescribed trimethoprimpolymyxin B ophthalmic solution for children with presumed acute bacterial conjunctivitis reported that this medication was effective and well tolerated.

Comparative clinical study of norfloxacin 0.3% and chloramphenicol 0.5% ophthalmic solutions in the treatment of acute bacterial conjunctivitis, blepharitis, and blepharoconjunctivitis

We carried out a double-blind clinical study to compare the efficacies of norfloxacin and chloramphenicol ophthalmic solutions in the treatment of patients with acute bacterial conjunctivitis, blepharitis, or blepharoconjunctivitis. Forty-one patients were included and randomized into two groups, and each patient was treated with two drops of the corresponding drug every 2 hours during the first day, and two drops four times a day for 6 additional days. Severity of signs and symptoms was statistically similar in both groups, according to the chi-squared test for statistical significance. Norfloxacin ophthalmic solution proved to be as effective as that of chloramphenicol in the treatment of acute bacterial conjunctivitis, blepharitis, or blepharoconjunctivitis.

Topically Administered Norfloxacin Compared with Topically Administered Gentamicin for the Treatment of External Ocular Bacterial Infections

In this double-masked study, we randomly assigned 488 patients with clinical signs of acute bacterial conjunctivitis or blepharitis, or both, to treatment with either norfloxacin ophthalmic solution 0.3% (245) or gentamicin ophthalmic solution 0.3% (243) for one week. Of the patients with positive cultures, 71% (85 of 120) of the norfloxacin-treated patients and 65% (86 of 133) of the gentamicin-treated patients were clinically cured. An additional 25% (30 of 120) of norfloxacin-treated patients and 32% (43 of 133) of gentamicin-treated patients were clinically improved. On the basis of posttreatment cultures, 89% of all cultured bacteria were eradicated (146 of 179 organisms) or suppressed (14 of 179 organisms) after treatment with norfloxacin. The condition of five norfloxacin-treated patients did not clinically improve, compared with the condition of eight gentamicin-treated patients. Both antibiotics had similar efficacy against gram-positive and against gram-negative organisms. One norfloxacin-treated patient and two gentamicin-treated patients withdrew from the study because of local intolerance. Norfloxacin appears to be an effective and relatively safe agent for the treatment of bacterial infections of the eyelids or conjunctiva, or both. In this study, norfloxacin was clinically and microbiologically similar in activity to gentamicin.

Primary Meningococcal Conjunctivitis: report of 21 Patients and Review

Neisseria meningitidis is an uncommon cause of acute bacterial conjunctivitis. Twenty-one cases of primary meningococcal conjunctivitis (PMC) are reported herein and 63 cases published in the literature since 1899 are reviewed. In the 84 cases of PMC available for analysis, the male-to-female ratio was 1.76:1; nine of the patients were neonates, 55 were children, and 20 were adults. Conjunctivitis was unilateral in 66.3% of the patients. Gram stain of conjunctival exudate disclosed gram-negative diplococci in all cases in which it was done. Culture of the conjunctival exudate yielded N. meningitidis in all cases, and 44% of the isolated meningococci belonged to serogroup B. Ocular complications, which occurred in 15.5% of the patients, most frequently were corneal ulcers. Systemic meningococcal disease developed in 17.8% of the patients; the overall mortality was 13.3% for patients with PMC complicated by systemic disease. Development of systemic disease was significantly more frequent in patients receiving only topical therapy than in those treated with systemic therapy (31.71% vs. 2.38%; P = .001). Gram-negative diplococci observed in conjunctival exudate are an indication for systemic antibiotic therapy because of the risk of systemic complications associated with the use of topical therapy alone. When properly treated, patients with PMC have a favorable prognosis.

Invasive Meningococcal Conjunctivitis

To the Editor.— Systemic meningococcal infections are presumed to follow spread of meningococci from the nasopharynx into the blood and then to the cerebrospinal fluid.1However, there have been reports of at least 10 cases of systemic meningococcal infection in which the conjunctiva was the probable portal of entry.2-11The overall incidence of invasive meningococcal conjunctivitis has been estimated to be about 10% of the cases of primary meningococcal conjunctivitis.12 Neisseria meningitidiswas isolated from conjunctival exudate in 21 patients with acute bacterial conjunctivitis who were treated at our hospital during the last 5 years. During this period, 1030 patients with a microbiologically proved acute bacterial conjunctivitis were diagnosed, which gives an incidence forN meningitidisconjunctivitis of 2.0%. Six (28.6%) of our 21 patients with primary meningococcal conjunctivitis, after a mean interval of 27.1 (±23.8) hours from the appearance of the initial ocular symptoms, developed systemic

Pneumococci in ocular disease of children and their treatment

A total of 171 isolates of Streptococcus pneumoniae were obtained from eyes of children who had congenital dacryocystitis, congenital cataract and glaucoma, acute bacterial conjunctivitis, corneal ulceration, nasolacrimal duct block, or discharging socket, or who had developed ectropion, endophthalmitis and orbital cellulitis. The highest number of strains was obtained from cases of dacryocystitis (74.4%), followed by conjunctivitis (8.2%) and those having developed nasolacrimal duct block (7.6%). The least overall resistance was to erythromycin (17.6%) and chloramphenicol (31.0%). Erythromycin being unavailable for ocular use in India, chloramphenicol was reported to be one of the best drugs against pneumococcal ocular infections in children, the other being cloxacillin, a 2.5% solution of which is made from injectable cloxacillin and used as an ophthalmic preparation. Their use on patients has met with considerable success. Nineteen out of 20 isolates were typeable--the types being 3, 46, 8, 28, 29, 45, 21 and 18. To the best of our knowledge, this is the first report from a developing country of serotyping ocular strains of pneumococci.

Acute bacterial conjunctivitis. Bacteriology and clinical implications.

We report the results of eye culture specimens, obtained from patients under 20 years of age, submitted to the Bacteriology Department of our institution from January 1 through April 30, 1983. A total of 72 specimens were positive for one or more strains of bacteria. The most commonly isolated bacteria was Hemophilus influenzae (34 strains, 42%), followed by Staphylococcus epidermidis (11 strains, 13.75%) and Streptococcus pneumoniae (9 strains, 11.25%). Mean age of patients with H. influenzae (excluding a 20-year-old patient) was 15 months with standard deviation of 13 months. Chloramphenicol and tetracycline showed excellent in vitro activity against bacteria of all age groups. Tetracycline may prove to be the drug of choice for the treatment of acute conjunctivitis if comparative clinical data support its in vitro superiority.

Efficacy of topical antibiotic therapy in acute conjunctivitis in children

We studied 102 children aged 1 month to 18 years in a randomized, double-blind trial designed to determine both the natural history of bacterial conjunctivitis and whether topical antibiotic therapy is beneficial. Affected eyes were treated four times a day for 7 days with drug (polymyxin-bacitracin ophthalmic ointment) or placebo. Eighty-four patients had proved bacterial conjunctivitis (Haemophilus influenzae 61, Streptococcus pneumoniae 22, both one); 66 of these received only topical therapy. By 3 to 5 days, 21 of 34 (62%) patients receiving topical antibiotic were clinically cured, whereas only nine of 32 (28%) patients given placebo were cured (P less than 0.02). By 8 to 10 days, 31 (91%) of the patients given antibiotic and 23 (72%) of the placebo group were cured (P = NS). The bacterial pathogen was eradicated by day 3 to 5 in 71% and by day 8 to 10 in 79% of patients given antibiotic, compared to 19% and 31% of the placebo group (P less than 0.001). Acute bacterial conjunctivitis is a self-limited disease, but topical antibiotic therapy with polymyxin-bacitracin shortens the duration of clinical disease and enhances eradication of the causative organism from the conjunctiva.

Acute bacterial infections of the eye: their aetiology and treatment.

The aerobic microbial flora of 823 eyes with acute bacterial conjunctivitis, corneal ulceration, dacryocystitis, discharging sockets, blepharitis, and postoperative infections has been investigated. Staphylococci, Streptococcus pneumoniae, and nonfermenting Gram-negative bacilli including Pseudomonas aeruginosa were the main pathogens. Fermenting coliforms were also infrequently isolated. The least overall resistance of 30.9% was to chloramphenicol, but no one antibiotic was effective against all pathogens. Cloxacillin is the best drug for staphylococcal and polymyxin B for pseudomonas infections.

Immunoassay of tear lysozyme in conjunctival diseases.

The tear lysozyme content in 111 normal subjects and in 159 patients with various conjunctival diseases was determined by a single radial immunodiffusion technique. Tear lysozyme level in normal people was 1.33/mg/ml. (SI conversion: mg/ml = g/l.) The mean tear lysozyme levels in patients with chronic irritative conjunctivitis (0.97 mg/ml) and nutritional deficiency with epithelial xerosis (0.76 mg/ml) were significantly lower than in the normal controls. The mean tear lysozyme levels in tears from patients with vernal conjuctivitis (1.20 mg/ml), phlyctenular conjunctivitis (1.10 mg/ml), and acute bacterial conjunctivitis (1.48 mg/ml) were not significantly different from those in the normal controls. Superimposition of acute bacterial conjunctivitis on trachoma did not alter the low tear lysozyme level that existed before in these patients.

Aetiology and treatment of acute bacterial infection of the external eye.

The microbial flora of 738 patients with acute bacterial conjunctivitis, corneal ulceration, blepharitis, dacryocystitis, and discharging sockets has been investigated. Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae were the main pathogens isolated. Str. viridans was associated with conjunctivitis in patients aged under 1 year. moraxella sp. was isolated on only one occasion. Overall, 40% of specimens were associated with Staph. epidermidis or mixed skin flora, which also occurred with cultures of the normal eye. Clostridium welchii was isolated on 3 occasions but was not associated with bullae or gas gangrene. The least overall resistance, of 6%, was to chloramphenicol, but no one antibiotic was effective against all pathogens. Gentamicin remains the antibiotic of choice for Pseudomonas aeruginosa infection.

Immunoglobulin concentrations in human tears in ocular diseases.

Immunoglobulin concentrations in human tears were determined in 165 patients with different eye diseases by a standard radial immunodiffusion method. IgA was present in all the samples in measurable quantity. The mean IgA values were significantly higher than the controls in patients with acute bacterial conjunctivitis, keratomalacia, corneal graft reaction, blepharoconjunctivitis, and acute keratoconjunctivitis. The values in the patients with vernal conjunctivitis, phlyctenular conjunctivitis, acute bacterial corneal ulcer, and acute endogenous uveitis were not significantly different from those in the controls. IgG could be detected in the majority of the samples but it was in measurable quantity in 18 samples. IgM could be detected in fewer samples. IgD was not detected in any of them. The study indicates that, whenever the immunoglobulin levels in tears are altered in diseased eyes, it is the IgA level that is predominantly altered and not the IgG level.

Acute bacterial conjunctivitis in Assiout, Upper Egypt. A one-year study.

Acute bacterial conjunctivitis in Assiout, Upper Egypt. A one-year study.

Peripheral ulcerative keratitis triggered by bacterial conjunctivitis

Periphpral ulcerative keratitis (PUK) is a disorder consisting of a crescent-shaped destructive inflammation of the perilimbal corneal stroma. We present a case of PUK following acute bacterial conjunctivitis in a 60-year-old lady with a history of on-and-off joint pain for two years. After admission to the hospital, she underwent conjunctival resection and was given topical and oral steroids. She was prescribed hydroxychloroquine after confirming the diagnosis of rheumatoid arthritis with a positive RA factor. This report highlights the role of infection as a triggeringagent in the induction of PUK in an otherwise quiescent cornea.