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Fusidic Acid in Infections of the External Eye

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Fusidic Acid in Infections of the External Eye Orig ina lia _ ______________________________ O. P. va n Bijsterveld, Y. el Batawi, F. S. Sobhi, M. W. Nassar Fusidic Acid in Infections of the External Eye Summary: A newly developed 1% eye preparation of philus aegyptius (10%), Streptococcus pneumoniae the potent antistaphylococcal antibiotic fusidic acid , (13%) and Neisseria gOllorr/weae (6%). The overall showed an excellent clinical effect in 206 Egyptian chil­ clinical success rate in children with bacterial conjunc· dren with external eye infections. The 248 patients in­ tivitis was 85% with fusidic acid, compared to 48% cluded in the study were randomized, in the ratio 5:1. wi th chloramphenicol (p < 0.001). The better effect of to either fusidlc acid or chloramphenicol 0.5% eye fusidic acid could be ascribed to a lower frequency of drops. Both preparations were given four to six times in vitro resistance (16%) in comparison to chlor­ dai ly for one week. Bacterial conjunctivitis was diag­ amphe ni col (55 %). Both drugs were apparently well nosed in 56% of the children. Offending eye pathogens tolerated and no side-effects we re observed. were mainly Slaphylococcus aureu.s (60%), Haemo- Zusammenfassung: Fusidinsiiure wr Be}umdlung I'on Cll.\' aurells (60%), Haemophilus aegypliw (10%), eXlemen Augenllljeklionen. Einc ncuentwickehe Streptococcus plleumoniae (13%) und Neisseria gonor­ 1%ige ophthalmologische Priiparation des gegen Sta· rhoeae (6% ). Mit Fusidinsiiure wurde bei 85 % der phylokokken hochwi rksamen Antibiotikums Fusidin­ Kinder mi t bakterie ller Konjunktivitis ein Therapieer­ saure erwies sich bei 206 iigyptischen Kindem mit ex­ folg erzielt. mit Chloramphenicol in 48% der Fii ll e terncn Augcninfektionen ab hervorragend klinisch (p < O,OOL). Die therapeutische Oberlcgenheit von wirksam. Die im Rahmen der Studie behandehen 248 Fusidinsaure lieB sich darauf zuriickfilhren, daB die In Kinder erhielten oath Randomverfahren im Verhalt· vitro-Resistenz der Erreger mi t 16% der Isolate in der nis 5: I entweder I %ige Fusidinsaure· oder 0,5%ige Fusidinsaure-Gruppe geringer war als in der Chlor­ Chloramphenicol·Augentropfen. Beide Priiparate amphenicol-Therapiegruppe mit einer Resistenzrate wurden cine Woche lang vier- bis sechsmal tiiglich vcr· vo n 55% deT Isolate. Beide Medikamente wurden of­ abreicht. Bei 56% der Kinder wurde cine b(lktericlle fensichtlich gut vert ragen, Nebenwirku ngen wurden Konjunktivitis diagnostiziert. Die haufigsten pathoge­ nicht beobachtet. nen Erreger der Augeninfektionen waren Staphylococ- Introduction Emerobacleriaceae and Pselldomonas spp. (8). Thus. the antibacterial spectrum of fusidic acid covers the majority External bacterial infections of the eye are most frequent­ of the common eye pathogens. In view of the increase in ly caused by the common skin b(lcteria. In acute conjunc· bacterial resistance. increasing reports on idiosyncratic tivitis the organisms recovered in order of their frequcncy depression of the hematopoetic system, as well as allergic have been reported to be staphylococci, streptococci, contact reactions (II), there would seem to be a need for Haemophilus spp., Moraxella spp., Pseudomollas spp., alternative eye anti-infecti ves. Recent ly. fusidic acid has Neisseria spp., and ElIlerobaCleriaceae; and in chronic been introduced as a I % viscous aqueous suspension, and conjunctivitis staphylococci arc by far the most common we report here the resu lts of one of the fi rst clinical stud­ bacterial palhogen (I). Fusidic acid is potent anti-sta­ a ies with this new eye anti-infective in the treatment of phylococcal antibiotic which, since ils introduction in conjunctiVitis in children where chloramphenicol eye L962, has been used both systemically in severe staphylo­ drops have been chosen as t he active control preparation. coccal infections and topicall y in skin infections (2-7). Fu· sidic acid acts by inhibition of hacterial protein synthesis. Patients and Methods It is not inactivated by 0-lactamases, and there is no cross· resistance between fusidic acid and other antibiotics in I'Uliell/s: The siudy includes 248 children, who during a onc­ clinical use (S--IO). Most staphylococci, regardless of thei r month period - July 1983 - were consecutively admitted wilh an susceptibility to other antimicrobial drugs or their produc· tion of penicillinase, are very sensitive to fusidic acid , Received: 18 Junc 86tAccepled: 29 Septcmber 86 with MIC values of 0.01 to 0.5 mgtl. Fusidic acid is also moderately active against streptococci, diplococci, gono­ O. p. "all Hi;Sl~rveld. M.D .• Ph.D .. Koninklijk Nederlands voor Oog· lijders. Utrecht , Holland; cocci and some J-Jaemophilus species including Haemo­ Y. e/ Halow;. M .D .. Ph.D .. F. S. SQbhi . M .D .. Ph. D .. M. W. Nosser, philus aegYPlius and Moraxefla spp., but inactive against M.D .. University of Cairo. Egypt. 16 / 20 Infcction 15 (1987) Nr. t C! MMV Mcdizin Vulag GmbH MUnchcn. MUnchen 1987 O. P. van BijSlerveld et al.: Fusid ic Acid in Eye Infections Table 1: Demographic data and type of conjunctival infection in 248 children included in the study. S" Age (in yean) Infection type Diagnosis Single So'" F M <2 2-<> 7-l5 'Y' 'Y~ Bacterial 63 76 97 33 9 15 I" Mixed 12 23 27 6 2 I 34 Viral 29 " 'I 23 10 I' 60 Total I" '" 165 62 21 30 218 external eye infection 10 the Paediatric Clinic at Kasr el-Aini te ri al pathogens. Thirty-five children were diagnosed as Hospital, Cairo University. The group of children comprised having a mixed bacteriaVviral infection, characte rized by 144 males and 104 females. 165 subjects were under twO years of a serous conjunctival exudate , but with a positive bacterial age. 62 were aged two to six, and 21 we re between seven and 15 culture, which in most cases revealed diphtheroids. Final­ years of age (Table I). There were no drop-ouls. ly, 74 children with negative baclerial culture but clinical Methods: At the first visit 10 the clinic the children were signs of conjunctivitis were classified as having viral con­ diagnosed as follows: Acute conjunclivitis, defined as a disease junctivitis (Table I). with a history of less than one week, as subacute cases, with a disease hislOry from one to four weeks, or as chronic cases. Con­ The clinical response to treatment was evaluated imme· junctival exudale was ch3Tacteriud as mucoid , mucopurulent , diately after the seven-day course. Children with a bacte· purulent. or serous, and the following clinical signs and symp­ rilll conjunctivitis who received fusidic acid were found to toms were graded on a scale 0 = absent to 3 .. severe according have a success rate of85% (97/ 11 4), an im provement rate to the amount of conjunctival exudate, degree of conjunctival of 8% (91114) , and a fai lure rate of 7% (8/114). Corre­ injection, conjunctival oedema , periorbital oedema, corncal in ­ spondi ng figures for chloramphenicol treatment were 48% fil tration, corneal erosions and staining intensity with Rosel3en­ (\2125), 4% (1125), and 48% (12/25). These differences gal. At the second clinic visit, after olle week of treatment, the are stalistically highly signicifant (p < 0.0001; Chi-square same clinical signs were graded, and th e overall clinical effect of test). In children with mixed bacteriallviral conj unctivitis, treatment was reco rded as either success, improvement, failure, there were no cases o f complete clinical success. Fusidic or not evaluable. acid produced an improvement in 16 of 27 children, and Test drugs: Fusidic acid was used as a 1% microcrystalline sus­ chloramphenicol in two of eight chi ldren (p := 0.12; Chi ­ pension in a carbopol gel. with benzalkonium chloride and square tesl). Among children with vira l conjunctivilis, all EDT A used as presetvative (Fucithalmic<S - Leo Pharmaceuti­ cal Products). Chloramphenicol was administered as the com­ nine cases treated with chloramphenicol were treatment mercially available 0.5% eye drops (Kloramfe ni ko]S OAK). failures, and 63 of 65 o n fusidic acid showed a failure. The two test preparations were given in an open , randomised Among children with bacterial eye infecti ons receiving fu­ manner, so that every fifth child received chloramphenicol. In sidic acid, there was one failure in 59 chi ldren with acute all cases the treatment period was seven days, and the eje prep­ conjunctivitis, compared to six fa ilures in 56 children with arations were given four to six times d3ily , according to the subacute o r chroni c conjunctivitis (Table 2). severity of the disease. Twenty of 139 children with bacterial conjunctivitis had a Specimens for microbiological investigation were oblained by a mixed infection. Among the 159 strains isolated, Staphy­ colton swab and direct plating on 5% sheep blood agar and lococcus aureus was by far the most frequently encounter­ chocolate agar. Significant isolates were identified and their ed pathogen (n "" 96), followed by Streptococcus pneumo­ antibiotic susceplibility tested using Becton Dickinson Sensi niae (n :: 20), H. aegyptius (n = 16) , Neisseria gOllOr­ Disc*. Susceptibilities on Mueller-Hinton agar are expressed as rhoeae (n = 9) , and streptococci (n = 9). It is interesting sensitive or resistant according to regression lin es with the following recommended break points: fusi dic acid 2 mg/l . chlor­ that only one Enterobacteriaceae strain (Escherichia coli) amphenicol 8 mg/I, tetracycline 4 mgll, penicillin 2 mg/l, methi­ and one strain of PseudomonQS sp. were isolated. In the cillin 3 mgll, erythromycin 0.5 mg/l , neomycin 2.5 mg/l and fusidic acid group, treatment fai lures were observed in in­ gentamicin I mgll. fections caused by S. aureus (n = 6), H. aegyptius (n = 2), Pseudomonas (n = 1), and E. coli (n = I). AU strains Results were resistant to fusidic acid in vitro. In the chloramphen­ icol group, aU12 treatment fa ilures were caused by S. au­ 206 children received fusidic acid and 42 children received reus >resistant in vitro to the drug. Children who showed the chloramphenicol eye preparation.
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