Topical Antimicrobials Research Articles

Эмпирическая терапия – первая линия в лечении вульвовагинальных инфекций

Women with signs of urogenital system infections require diagnostic testing for timely and adequate verification of the pathogen and prescription of therapy considering pathogen eradication. However, the identification of specific pathogens in practice takes some time. Therefore, empirical therapy based on a subjective evaluation of the symptoms of vulvovaginal infections and assessment of drug susceptibility of pathogens is common in practical gynecology. At the same time, it is acceptable to use broad-spectrum agents that act on bacteria, fungi, and protozoa and do not contribute to the development of antibiotic resistance. These are topical antimicrobial agents – antiseptics. Objective. To study the efficacy of dequalinium chloride as first-line treatment of patients with signs of vulvovaginal noninflammatory and inflammatory diseases initiated by opportunistic pathogens and aerobic bacteria. Patients and methods. The study included 74 women aged 18 to 45 years (31.4 ± 0.5 years) who were diagnosed with other inflammation of vagina and vulva (N76) or other non-inflammatory disorders of vagina (N89) based on their complaints and examination during an initial visit to a gynecologist. Prior to treatment, laboratory testing of the vaginal microflora by real-time polymerase chain reaction using the test Femoflor was performed, and empirical therapy with dequalinium chloride was applied. Subsequently, the results of laboratory tests before and after treatment were analyzed, as well as the dynamics of clinical manifestations of vulvovaginal infections against the background of therapy with topical antiseptic. Results. The prescription of dequalinium chloride as empirical therapy is effective for both elimination of the clinical manifestations of vulvovaginal infections and for normalization of the qualitative and quantitative composition of the vaginal microbiota at the outpatient appointment. Conclusion. Dequalinium chloride (Fluomisin®) may be recommended to women for correcting disorders of the vaginal microbiocenosis at their initial visit before the results of laboratory tests are obtained. Key words: vulvovaginal infection, normal microbiota, empirical therapy, dequalinium chloride

Рациональный подход к лечению наружного отита

In recent years, there has been an increased number of calls to ENT specialists concerning otitis externa. These conditions are characterized by antibiotic resistance of key pathogens, as well as the presence of significant pain symptoms. In 60–98% of cases, inflammation in the external auditory canal has a bacterial etiology. Pseudomonas aeruginosa occupies a leading place in the microbial landscape — up to 78% on average, while Staphylococcus aureus is sown only in 9–27% of cases. Rational therapy of otitis externa is one of the urgent problems of otorhinolaryngology, despite the large variety of treatment methods. It is necessary to use complex therapy of external otitis, including a direct effect on the etiological factor, as well as pain relief. In the vast majority of cases, the frontline empirical therapy of otitis externa should be topical antimicrobial agents. The following combined drug is successfully used for the treatment of otitis externa: ear drops containing a combined antibiotic (aminoglycoside neomycin + cyclic polypeptide polymyxin B + topical anesthetic lidocaine). Early therapy of otitis externa with a combined antibiotic is the key to a fast and reliable clinical result. KEYWORDS: otitis externa, bacterial otitis, ear drops, combined antibiotic, aminoglycoside, cyclic polypeptide, topical anesthetics, neomycin, polymyxin B, lidocaine. FOR CITATION: Gurov A.V., Muzhichkova A.V. Rational approach to the treatment of otitis externa. Russian Medical Inquiry. 2022;6(7):404– 410 (in Russ.). DOI: 10.32364/2587-6821-2022-6-7-404-410.

Clinical features of endophthalmitis clusters after cataract surgery and practical recommendations to mitigate risk: systematic review.

Intraocular transmission of exogenous pathogens in cataract surgery can lead to endophthalmitis. This review evaluates the features of endophthalmitis clusters secondary to pathogen transmission in cataract surgery. Articles reporting on pathogen transmission in cataract surgery were identified via searches of Ovid MEDLINE, EMBASE, and Cochrane CENTRAL, and a total of 268 eyes from 24 studies were included. The most common source of infectious transmission was attributed to a contaminated intraocular solution (ie, irrigation solution, viscoelastic, or diluted antibiotic; n = 10). Visual acuity at presentation with infectious features was 1.89 logMAR (range: 1.35 to 2.58; ∼counting fingers) and 1.33 logMAR (range: 0.04 to 3.00; Snellen: ∼20/430) at last follow-up. Patients with diabetes had worse outcomes compared with patients without diabetes. The most frequently isolated pathogen from the infectious sources was Pseudomonas sp. (50.0%). This review highlights the various routes of pathogen transmission during cataract surgery and summarizes recommendations for the detection, prevention, and management of endophthalmitis clusters.

A Rapid Method for the determination of Dehydrated alcohol (Ethanol) content in Clobetasol propionate foam by Non-polar Capillary Gas chromatography

Clobeatsol propionate foam is a topical class 1 corticosteroid used to treat itching and inflammatory arthritis on the skin occurred by allergic reactions, psoriasis and eczema. In the pharmaceutical aerosol products, Dehydrated alcohol (Ethanol) is the primary ingredient and its concentration level in the formulation composition plays a significant role in the regulation of aerosol rate, droplet shape and particle size. It can also act as solubilizer for active pharmaceutical ingredient, topical disinfectant and skin permeation enhancer. Hence accurate assay of Ethanol is a crucial quality control component. A simple and rapid gas chromatography method was developed to quantify Ethanol content in Clobetasol propionate foam drug product using fused silica glass tube non-polar capillary column (HP-5, 30 m, 0.53 mm, 1.5 µm). Ethanol in the sample was diluted with methanol after adding suitable amount of internal standard, the isopropyl alcohol solution.The developed method is precise, linear and accurate in the range of 5 mg/mL to 15 mg/mL of nominal concentration of ethanol i.e. 10 mg/mL . The presented method has an advantage of a very quick gas chromatographic separation (less than 16 min) and therefore is highly suitable for in-process and stability analysis of Ethanol content in Clobetasol propionate foam drug product.

Antimicrobial Activities of Propolis in Poloxamer Based Topical Gels.

Propolis contains a group of compounds with various activities. However, their low solubility is a drawback for the development of pharmaceutical formulations. In this study, poloxamers as a solubilizer and gelling agent were evaluated to develop a topical antimicrobial formulation of propolis. The effects of poloxamer type and concentration on the propolis solubility, release rate, and antimicrobial activities were investigated. Staphylococcus aureus (S. aureus) and Candida albicans (C. albicans) were the representative bacteria and fungi, respectively. At 5%, poloxamer 407 (P407) and poloxamer 188 (P188) enhanced the propolis solubility by 2.86 and 2.06 folds, respectively; at 10%, they were 2.81 and 2.59 folds, respectively. The micelle size in the P188 formulation increased in the presence of propolis, whereas there was no change in the P407 formulation. Release rates of propolis decreased with the P188 concentration increase, which was attributed to viscosity increase. Both P188 and P407 formulations showed antimicrobial activity against S. aureus in a time-kill kinetics assay. However, only the P188 formulation reduced the cell’s numbers significantly against C. albicans, compared to the control. We speculate that P188 mixed micelles were more effective in releasing free active compounds to exhibit anti-microbial activity compared to the P407 micelles encapsulating the hydrophobic compounds in their cores. Propolis in P188 formulation is proposed as a potential topical antimicrobial agent based on its activity against both S. aureus and C. albicans.

Role of topical nadifloxacin as an empirical treatment in patients with skin and soft-tissue infections in India: A review and consensus

Dermatologists often come across cases of skin and soft-tissue infections (SSTIs) which have diverse clinical presentations. Various local, systemic, and environmental risk factors predispose an individual to develop SSTIs. Topical antimicrobial agents are frequently used in superficial uncomplicated SSTIs, whereas systemic therapy is generally reserved for use in severe cases. However, emergence of resistance to these agents is becoming a common problem in clinical practice. This necessitates the use of other classes of antimicrobials for the effective treatment of SSTIs. Nadifloxacin, a potential drug belonging to the fluoroquinolone group, has various advantages such as binding to bacterial DNA gyrase and topoisomerase IV enzymes, inhibition of nor-A efflux pump, survival in acidic pH, anti-MRSA activity, and biofilms penetration. It has also shown least development of resistance since its introduction. Although its topical formulation has shown superior efficacy as an anti-acne agent, there are no specific guidelines for its appropriate use in SSTIs. Hence, a panel of experts was formed, under whose guidance an extensive literature search was performed in MEDLINE, Cochrane Library, and Science Direct databases. Using the modified Delphi technique, the available evidence was reviewed and corresponding recommendations were given for the use of topical Nadifloxacin as an empirical treatment in SSTIs.

Regression discontinuity of blood culture contamination rate after changing of disinfectants: retrospective observational study

Blood cultures are indispensable for detecting life-threatening bacteremia. Little is known about associations between contamination rates and topical disinfectants for blood collection in adults. We sought to determine whether a change in topical disinfectants was associated with the rates of contaminated blood cultures in the emergency department of a single institution. This single-center, retrospective observational study of consecutive patients aged 20 years or older was conducted in the emergency department (ED) of a university hospital in Japan between August 1, 2018 and September 30, 2020. Pairs of blood samples were collected for aerobic and anaerobic culture from the patients in the ED. Physicians selected topical disinfectants according to their personal preference before September 1, 2019; alcohol/chlorhexidine gluconate (ACHX) was mandatory thereafter, unless the patient was allergic to alcohol. Regression discontinuity analysis was used to detect the effect of the mandatory usage of ACHX on rates of contaminated blood cultures. We collected 2141 blood culture samples from 1097 patients and found 164 (7.7%) potentially contaminated blood cultures. Among these, 445 (20.8%) were true bacteremia and 1532 (71.6%) were true negatives. Puncture site disinfection was performed with ACHX for 1345 (62.8%) cases and with povidone-iodine (PVI) for 767 (35.8%) cases. The regression discontinuity analysis showed that mandatory ACHX usage was significantly associated with lower rates of contaminated blood cultures by 9.6% (95% confidence interval (CI): 5.0%–14.2%, P < 0.001). Rates of contaminated blood cultures were significantly lower when ACHX was used as the topical disinfectant.

ANTIMICROBIAL PROPERTIES OF RABBIT COLLAGEN GLUE-CHITOSAN BIOMATERIAL LOADED WITH CYMBOPOGON FLEXUOSUS ESSENTIAL OIL

One approach to develop innovative antimicrobial wound dressing materials is to use natural polymers loaded with antimicrobial agents. The valorisation of animal proteins as biomaterials with antimicrobial properties is a new concern for development of wound healing. Plant esssential oils (EO) also indicate a potential approach for new wound dressing materials able to replace the synthetic antymicrobial agents. In this paper, plant-polymeric film was prepared by casting film-forming emulsion based on lemongrass (Cymbopogon flexuosus) essential oil/Tween 80 dispersed into rabbit collagen glue hydrolysate– chitosan biomaterial. The effect of biomaterial film composition on Staphylococcus aureus ATCC 6538 and Escherichia coli ATCC 10536 standard bacteria, and Candida albicans ATCC 10231 pathogenic fungus was studied according to European Pharmacopoeia 10/2020 as compared with biomaterial film without essential oil. The in vitro antibacterial tests against three bacterial strains showed that the rabbit collagen glue hydrolysate–chitosan biomaterial inhibited all the three microorganisms. The rabbit collagen hydrolysate glue-chitosan film loaded with lemongrass essential oil exhibits antimicrobial activity towards tested microorganisms but lower as compared with control. The explanation could be due to the short time of investigation, or maybe some active compounds constituents of EO, which favour the cellular proliferation. Preparation of rabbit collagen glue hydrolysate-chitosan biomaterial loaded with lemongrass essential oil is an environmentally friendly solution, which may contribute to the development of wound healing materials as an alternative to topical antimicrobial agents.

Mupirocin Resistance in Staphylococcus aureus Isolated from Nasal Swabs of ICU and OT Staff- A Study from A Tertiary Care Hospital

Staphylococcus aureus is one of the common causes of Healthcare-associated infection. Staphylococcus colonizes the anterior nares of the nose and tends to disseminate and secondarily colonize several other body sites including the skin and the gut. Colonized hospital personnel may be an important factor in dissemination. Staphylococcus aureus to patients and vice-versa. Mupirocin is an excellent topical anti-staphylococcal antimicrobial agent used for eradicating nasal carriage. Resistance to Mupirocin is a threat for future use of this drug in eliminating nasal carriage of Staphylococcus aureus. Thus, this study was conducted to determine the rate of Mupirocin resistance among Staphylococcus aureus isolated from nasal swabs of Health care workers (HCWs ) of Operation Theatres (OTs) and Intensive Care Units (ICUs). A single nasal swab was collected from both the anterior nares of participating health care workers of ICU and OT once at the end of their shift. Antibiotic susceptibility testing of Staphylococcus aureus to various antibiotics was done by Kirby-Bauer disk diffusion method using CLSI guidelines. High and low-level Mupirocin resistance was determined. Among 282 nasal swabs collected, Staphylococcus aureus was isolated in 62 samples. Of Staphylococcus aureus 19 came out to be Methicillin-resistant (MRSA) and the remaining 43 Methicillin sensitive (MSSA). Mupirocin resistance was seen in 3 MRSA strains and 1 MSSA strain. Thus, overall 4/62 (6.5%) strains were MupR strains. Mupirocin is the most effective antibiotic used against colonization of Staphylococcus aureus in anterior nares. Resistance to this antibiotic is thus an alarm as well as a matter of great concern. Necessary steps, policies and guidelines need to be framed to stop the spread of this resistance.

Hybrid derivative of cathelicidin and human beta defensin-2 against Gram-positive bacteria: A novel approach for the treatment of bacterial keratitis

Bacterial keratitis (BK) is a major cause of corneal blindness globally. This study aimed to develop a novel class of antimicrobial therapy, based on human-derived hybrid host defense peptides (HyHDPs), for treating BK. HyHDPs were rationally designed through combination of functional amino acids in parent HDPs, including LL-37 and human beta-defensin (HBD)-1 to -3. Minimal inhibitory concentrations (MICs) and time-kill kinetics assay were performed to determine the concentration- and time-dependent antimicrobial activity and cytotoxicity was evaluated against human corneal epithelial cells and erythrocytes. In vivo safety and efficacy of the most promising peptide was examined in the corneal wound healing and Staphylococcus aureus (ATCC SA29213) keratitis murine models, respectively. A second-generation HyHDP (CaD23), based on rational hybridization of the middle residues of LL-37 and C-terminal of HBD-2, was developed and was shown to demonstrate good efficacy against methicillin-sensitive and methicillin-resistant S. aureus [MIC = 12.5–25.0 μg/ml (5.2–10.4 μM)] and S. epidermidis [MIC = 12.5 μg/ml (5.2 μM)], and moderate efficacy against P. aeruginosa [MIC = 25-50 μg/ml (10.4–20.8 μM)]. CaD23 (at 25 μg/ml or 2× MIC) killed all the bacteria within 30 min, which was 8 times faster than amikacin (25 μg/ml or 20× MIC). After 10 consecutive passages, S. aureus (ATCC SA29213) did not develop any antimicrobial resistance (AMR) against CaD23 whereas it developed significant AMR (i.e. a 32-fold increase in MIC) against amikacin, a commonly used treatment for BK. Pre-clinical murine studies showed that CaD23 (0.5 mg/ml) achieved a median reduction of S. aureus bioburden by 94% (or 1.2 log10 CFU/ml) while not impeding corneal epithelial wound healing. In conclusion, rational hybridization of human-derived HDPs has led to generation of a potentially efficacious and safe topical antimicrobial agent for treating Gram-positive BK, with no/minimal risk of developing AMR.

Clinical course of peritoneal dialysis-related peritonitis due to non-tuberculosis mycobacterium – A single centre experience spanning 20 years

Peritoneal dialysis (PD)-related peritonitis caused by non-tuberculous mycobacteria (NTM) are difficult to diagnose, is associated with significant morbidity and mortality, and clinical course remains unclear. We determined the prevalence and clinical course of peritonitis caused by these organisms through our kidney registry over 20-year period. We reviewed all patients with NTM peritonitis identified in our tertiary centre between July 2000 and July 2020. The demographic characteristics, microbiological and clinical outcomes were examined. Among 27 patients identified, 20 patients presented with abdominal pain and all had cloudy peritoneal fluid. Twenty-one cases had concomitant exit site infection and 14 cases had prior antibiotic use. The majority of the cases are caused by Mycobacterium chelonae (37%) and Mycobacterium fortuitum (29.7%), with most being resistant to fluoroquinolones (59.3%) and cefoxitin (73.1%). They are all sensitive to amikacin otherwise. None of the cases achieve primary response at day 10 and 20 cases resulted in Tenckhoff catheter removal. Only two of them were able to resume PD. Eight patients died in our cohort. The presence of exit site infection, the use of prior antibiotics and topical disinfectants did not associate with a poorer outcome. NTM peritonitis remains difficult to treat and often with a delay in diagnosis. Refractory peritonitis with negative culture and a poor response to standard antibiotics should raise a possibility of NTM infection and prompt catheter removal and an expert with experience treating NTM infections should be consulted.

Wide local excision of the vulva for premalignant or benign lesions: do antibiotics decrease the risk of postoperative wound complication?

Objectives: To investigate determinants of wound complication following wide local excision (WLE) of the vulva for suspected premalignant or benign disease at a tertiary care center over the years 2016 to 2020. To determine factors associated with perioperative antibiotic use for WLE of the vulva and whether preoperative intravenous (IV) antibiotics or postoperative topical antimicrobial agents are associated with a decreased risk of wound complication. Methods: Consecutive patients were identified who underwent wide local excision of the vulva for suspected premalignant or benign lesions between June 1, 2016 and February 28, 2020. IRB approval was obtained and surgical records were reviewed; patients undergoing ‘wide local excision, vulva,’ ‘simple partial vulvectomy,’ or ‘destruction of vulvar lesion with excision’ were considered for inclusion. Demographic, peri- and postoperative, and pathologic data were recorded. Dimensions of specimen and elliptical surface areas were recorded. Patient follow up was documented at least through the postoperative appointment. Patients were separated by receipt of preoperative IV antibiotics or postoperative antimicrobial agents and by postoperative wound complications. Fisher's exact tests and Chi squared tests were used to compare categorical variables between groups and logistic regression models were used for continuous variables. P-values Results: Three-hundred thirty-five patients met inclusion criteria over the study period. One-hundred forty-one patients developed a wound complication (42%); this included 134 wound separations (40%), 22 infections (6.6%), and 4 hematomas (1.2%). Thirty-two patients (9.6%) received preoperative IV antibiotics and 42 (12.5%) received postoperative topical antimicrobial agents. Neither IV nor topical antimicrobial agents were associated with a decreased risk of wound complication (RR 0.96, 95% CI 0.62-1.49; RR 0.99, 95% CI 0.66-1.48). Demographics and preoperative characteristics were similar between those who received and did not receive antibiotics. Antibiotic administration was not associated with the maximum length or total surface area of excisions, number of vulvar excisions per surgery, or indication for WLE. Preoperative antibiotic use was similar between the gynecologic oncology and general gynecology divisions (RR 1.23, 95% CI 0.59-2.59). Patients who received IV antibiotics were more likely to be undergoing concurrent hysterectomy or other laparoscopic procedure (RR 12.8, 95% CI 7.87-20.75). Conclusions: WLE of the vulva is a common procedure among gynecologic oncologists and general gynecologists and carries a high rate of wound complication. Recent ERAS guidelines report low-level evidence to consider preoperative antibiotics for WLE and do not comment on topical antimicrobials.[1] In our study neither preoperative antibiotics nor postoperative topical antimicrobials were associated with improved outcomes. Prospective data on this topic is lacking and should be an area of future research. Antibiotic use for WLE-in the absence of concurrent clean-contaminated procedures-appears to be guided by surgeon preference.

Acetic acid dressings used to treat pseudomonas colonised burn wounds: A UK national survey

IntroductionWound infection following burn injury can be clinically challenging to manage. Its presence in a thermally compromised patient can detrimentally affect the ability of the wound to heal leading not only to wound progression but ultimately contribute to a large part of the economic health burden expenditure in the National Health Service. Despite meticulous wound care and infection control measures the colonisation of burn wounds by bacterial pathogens has and continues to be the case.There has been a growing interest in the use of antimicrobial applications when managing localised burn wound infections due to a constantly increasing number of antibiotic-resistant organisms. AimTo survey which antimicrobial dressings are currently being used across UK burns services when managing localised pseudomonas wound infections. MethodsWe conducted a nationwide telephone survey of UK burns services during October 2019 to determine which topical antimicrobial agent was used to treat local pseudomonas burn wound infections. ResultsSix burns services (31.6%) used acetic acid-soaked dressings, one of which alternates acetic acid with sodium hypochlorite solution. Silver-based dressings were also used by six burns services (31.6%) – again, one department alternates silver-based dressings with sodium hypochlorite solution. Betadine-soaked, gauze-based dressings were used across five burns services (26.3%) and the remaining two burns services (10.5%) used sodium hypochlorite solution and non-medicated dressings respectively. ConclusionWe identified a significant difference in the UK burns services’ approach to pseudomonas burn wound infections.Our literature review demonstrates that a daily dressing regime of 2.5–3% acetic acid is a well-tolerated treatment regime in burn patients and that it is in use in UK burns services. There are no current randomised controlled trials that evaluate the usage of acetic acid. The variation in usage suggests that there is scope for further study in order to develop evidence to generate a UK wide approach based on national standardised guidelines.

The influence of a biofilm-dispersing wound gel on the wound healing process.

Topical antimicrobials that reduce the bacterial bioburden within a chronically‐infected wound may have helpful or harmful effects on the healing process. We used murine models of full‐thickness skin wounds to determine the effects of the novel biofilm‐dispersing wound gel (BDWG) and its gel base on the healing of uninfected wounds. The rate of wound closure over 19 days was comparable among the BDWG‐treated (BT) wounds and the controls. Compared with the controls, histology of the BT wounds showed formation of a stable blood clot at day 1, more neovascularisation and reepithelialisation at day 3, and more organised healing at day 7. Fluorescence‐activated cell sorting analysis showed a lower percentage of neutrophils in wounded tissues of the BT group at days 1 and 3, and significantly more M2 macrophages at day 3. Levels of proinflammatory cytokines and chemokines were increased over the uninjured baseline within the wounds of all treatment groups but the levels were significantly lower in the BT group at day 1, modulating the inflammatory response. Our results suggest that BDWG does not interfere with the wound healing process and may enhance it by lowering inflammation and allowing transition to the proliferative stage of wound healing by day 3.

Application of bacterial nanocellulose-based wound dressings in the management of thermal injuries: Experience in 92 children

BackgroundManagement of pediatric thermal injuries involves a high standard of care in a multidisciplinary setting. To avoid physical and psychological sequelae, wound dressings should minimize hospitalization time and anesthesia while maximizing patient comfort. Patients and methods190 children with thermal injuries of the torso, arms and legs were treated with polyurethane foam dressings or bacterial nanocellulose sheets. Data were analyzed retrospectively regarding hospitalization, procedures with general anesthesia, scar formation, rate of infection and need for skin grafting. ResultsThe groups did not differ significantly concerning age, gender distribution or percentage of injured total body surface area. Statistical analysis showed that length of hospitalized care and procedures undergoing anesthesia were significantly reduced in the nanocellulose group (each p < 0.0001). There was no significant difference in rate of complications, wound healing and rate of skin grafting between the two subgroups. DiscussionActing as a temporary epidermal substitute, bacterial nanocellulose enables undisturbed reepithelialization without further wound dressing changes. In children, no additional topical antimicrobial agents are indicated for unimpaired wound healing. ConclusionsBacterial nanocellulose is superior to polyurethane foam regarding length of hospitalization and number of interventions under anesthesia. It offers a safe, cost-effective treatment option and provides excellent comfort in pediatric patients.

Efficacy of riboflavin/UV-A corneal phototherapy as stand-alone treatment for ulcerative keratitis in horses

The purpose of this study was to assess the efficacy of riboflavin/UV-A corneal phototherapy in comparison with topical antimicrobials for the treatment of corneal ulcers in horses. Nineteen horses with a diagnosis of corneal ulceration were randomised to receive either corneal phototherapy (11 horses) or topical antimicrobial therapy (8 horses). The corneal phototherapy consisted in the application of a riboflavin-enriched ophthalmic solution onto the cornea for 20 min followed by cornea UV-A irradiation at 30 mW/cm&lt;sup&gt;2&lt;/sup&gt; for 3 min using a point-of-care UV-A device. A complete ophthalmological examination was performed at enrolment and then at day 1, 3, 7, 14, 21, 28, 35, 42, and 49 after treatment. The corneal ulcer was considered healed when the fluorescein staining was negative. The corneal phototherapy succeeded in the complete corneal wound healing in 91% cases (10/11 horses) by 12.7 ± 5.5 days. In the topical antimicrobial group, no horse showed improvement of the corneal ulceration (0/8; 0%) and two eyes had a corneal perforation. Six horses, due to an enlarged corneal lesion, underwent corneal phototherapy at day 14 and achieved complete wound healing by 17.2 ± 5.5 days in 83% cases (5/6). The corneal phototherapy was shown to be an effective and safe treatment for equine corneal ulcers.

Pattern of Keratitis: A Study of 500 Cases in Tertiary Hospital of Bangladesh

Background: Keratitis is a potentially serious corneal infection and a major cause of visual impairment worldwide. Most common form of which is infectious variety; pathogens may be bacteria, viruses, fungi and parasites which varies with age and predisposing factors. Topical antimicrobials and cycloplegic agents are the mainstay of treatment. Pattern of causative organisms and drug sensitivity changes from time to time and differs from one to another geographic location.&#x0D; Objective: To assess and evaluate the pattern of diagnosed patient of keratitis presented in a tertiary hospital.&#x0D; Material and methods: This cross-sectional study was conducted on 500 diagnosed patients of keratitis in the department of cornea of National Institute of Ophthalmology &amp; Hospital, a well-known tertiary care hospital with 500 beds for a period of 6 months. Patients were selected based on specific selection criteria. Detail history was taken, and thorough ocular examination was done in every patient. Corneal scrapings were taken for Gram’s stain and 10% potassium hydroxide wet mount preparation. All the relevant data was recorded in a predesigned data collection sheet.&#x0D; Results: The mean age of the study subjects was 38.49 years. Male (43.2%) and female (56.8%) ratio was almost equal. The prevalence was highest among lower economic class (56.8%) as usual, and lowest among affluent class (3.8%) but not sparing them. In terms of regional distribution, majority (42.6%) of the patients came from rural area, whereas 37% from urban non-slum area and 20.8% from urban slum area. The problem was mostly observed among day-laborers (24.8%) with gradually declining trend among students (20.6%), housewives (20%), service holders (14.2%), businessmen (3.2%) and unemployed (2.2%), surprisingly! Presentation of the cases were mostly in between 2nd-3rdweek (55%), while 30% patients were presented within 1st week &amp; 15% after 4 weeks of diagnosis. Among the cases, it was found that 28.8% patients had corneal injury, which were caused by vegetative trauma in 16% cases, 4% dust or sand trauma, 2.8% animal injury, 2.2% stick injury, 1% nail injury and 2.8% patients had history of other injury like stone, wooden materials, flying insects, dirty wire etc. Ocular diseases predispose to corneal ulcer were present in 9% patients. These were chronic dacriocistitis, entropion and trichiasis. 1.2% patients were diabetic, and 1% patients had history of inadvertent use of steroids. On the contrary, there were no specific predisposing factors in 71.2% cases. Among the cases, 96.6% experienced photophobia, 90% had foreign body sensation, 88.4% had reduced vision, 85.4% had eye pain, 78.8% suffered from watering, 73.6% had discharge, 48.8% had burning sensation, 12.2% had decreased corneal sensation and 11.2% patients noticed white spot in cornea in first stage. Slit lamp bio-microscopic examination of the patients shows 90% patients had conjunctival injection, 70% had epithelial defect, 28.6% patients had stromal infiltration, 18.4% patients had hypopyon, 14% patients had feathery pattern, 8.8% patients had suppuration, anterior chamber reaction was present in 4.4% cases and 2.2% patients had satellite lesion. The evaluation of etiology on the basis of clinical appearance reveals 61.4% of cases were presented with viral keratitis, 23.0% fungal corneal ulcer, 11.4% with bacterial corneal ulcer, 2.2% with marginal keratitis, 0.8% with exposure keratitis, 0.8% with filamentary keratitis and 0.4% cases with Acanthamoebic keratitis at the time of presentation. While assessing the depth of keratitis of the study subjects, 73.2% found superficial while 26.8% found deep. Assessment of area of corneal involvement in terms of punctate epithelial defect showed that in 46.8 % cases less than 3mm of cornea was involved, 3 to 6 mm of the cornea involved in 19.6 % cases and in 11.8 % corneal involvement was found in more than 6 mm area. Corneal scraping done in 118 (23.6%) out of 500 patients. Among them, Fungi were found in 11.2% cases, mixed organism in 4%, Bacteria in 5.6% and Acanthamoeba found in o.4% cases while 2.4% remains unidentified.&#x0D; Conclusion: Analysis of the study findings shows diversity in the pattern, presentation, predisposing factors of different form of keratitis which may be helpful as basis of further study on this problem.

Effectiveness and Safety of Compound Polymyxin B Ointment in Treatment of Burn Wounds: A Meta-analysis.

Burn injuries represent a global public health concern. The guidelines for burn care mention that the treatment of burn injuries depends on the type of burn injury, depth of tissue, area of wounds, and site on the body. At present, several topical antimicrobial agents are used in the treatment of burn wounds as a first choice. This study aims to investigate the effectiveness of the compound polymyxin B topical agents for the treatment of burn wounds. PubMed, Web of Science, ProQuest, and China National Knowledge Infrastructure databases were searched for articles published until January 2021. The studies that conducted clinical trials comparing compound polymyxin B ointment with other treatment reagents for burn wound treatment were included. A total of three outcomes, which were investigator-assessed clinical response, including mortality, bacterial counts, efficacy and safety were included for analysis in this study. In total, 12 randomized controlled trials, 1 clinical trial, 2 prospective studies, and 1 retrospective study were extracted. The result of mortality showed no significant difference (risk ratio [RR]: 0.70, 95% CI: 0.21-2.31, P = .56); wound healing revealed an RR of 1.59 (95% CI: 1.40-1.81, P < .001); time to heal revealed a mean difference of -5.09 (95% CI: -6.31 to -3.86) days (P < .001); scar incidence was not significantly lower in the treatment group (RR: 0.70, 95% CI: 0.38-1.30, P = .26); and adverse event incidence was significantly lower in the treatment group (RR: 0.26, 95% CI: 0.09-0.72, P < .01). The compound polymyxin B ointment shows the effectiveness of increase in the wound healing and accelerates the time of healing with fewer adverse effects.

Местная антибиотикотерапия бактериальных инфекционно-воспалительных заболеваний переднего отрезка глаза

Inflammatory eye diseases are one of the most important problems of ophthalmology. They can be caused by various pathogens of the infection, which is still more often bacterial. Therapy of bacterial inflammatory diseases of the eye involves the use of antibacterial drugs (sulfonamides, antiseptics, nitrofurans, etc.), among which antibiotics are of primary importance. Of this group of drugs, in this review article, special attention is paid to quinolones, mainly synthetic fluoroquinolones, which are distinguished by a wide range of bactericidal action, fairly high efficiency, low level of resistance of microorganisms to it and the frequency of side effects, as well as good tolerability by patients, i.e. they best meet the requirements for modern topical antimicrobial agents. In certain clinical situations and indications, it is advisable to use ophthalmic antiseptics and combined preparations containing several antibiotics of different effects at once, or an antibiotic and a corticosteroid. Key words: infectious and inflammatory eye diseases, antibacterial agents, antibiotics, combined preparations, antiseptics.

Current updates on herbal oil vs synthetic antibiotics use for topical application

Topical skin infections represent some of the most common infectious sicknesses globally. Prevention and treatment of skin infections can involve utility of a topical antimicrobial, which may be an herbal oil and synthetic antibiotic drug. However, there's restricted evidence to aid the widespread rophylactic or healing use of topical agents. Challenges concerned inside the use of topical antimicrobials encompass growing costs of bacterial resistance, local allergy reactions. We evaluate the proof for the foremost scientific makes use of herbal oil and topical synthetic antibiotics. Herbal oils are traditional herbal treatments used to deal with several situations. 5% of plant oils used for dermatological usages, pores and skin moisturizing and skin care. The benefits of this sort of therapeutics encompass properly availability, local cultural elements and individual choices. the growing demand for herbal and organic merchandise, and the already established synergistic consequences of natural oil. Synthetic antibiotics are beneficial for topical administration to treating topical skin condition rather than the oral administration because of minimising the side effect of oral administration. Nowadays topical antibiotics is widely accepted effective and safe treatment for bacterial infection. In this review article comparison of the herbal oil Vs synthetic antibiotic drug for topical use.