Antibiotic/sterioid combination control BKC inflammation

June 1, 2007

In a randomized comparison study of two antibiotic/steroid combinations, tobramycin 0.3%/dexamethasone 0.1% controlled the clinical signs of inflammation more quickly than tobramycin 0.3%/loteprednol 0.5% in patients with moderate blepharokeratoconjunctivitis.

Study results, published in the January/February 2007 issue of Advances in Therapy, suggest that both compounds are appropriate for empiric use. However, tobramycin 0.3%/dexamethasone 0.1% is likely to result in greater patient comfort and satisfaction because it reduces ocular inflammation faster, said Francis S. Mah, MD, assistant professor of ophthalmology and co-medical director, Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh School of Medicine, Pittsburgh. He and Steven S. Rhee, DO, recently published their findings.

They examined 40 eyes of 40 patients with moderate BKC in at least one eye. At baseline, the ocular surface was graded for four components: blepharitis, conjunctivitis, ocular discharge, and corneal punctate epithelial keratopathy (PEK). These components were graded on a scale of 3 (extensive) to 0 (minimum); eyes with a total score >6 were included in the study. If both eyes met the defined score, the worse eye was used. Applanation tonometry and assessment of visual acuity were performed at baseline, and photographs were taken of all patients.

Before treatment was begun, no statistically significant difference was observed between the two groups for blepharitis (p = 0.31), discharge (p = 0.62), conjunctivitis (p = 1.0), or PEK (p = 0.57), or for total ocular inflammation (p = 0.87). Mean total ocular scores were 8.00 for tobramycin 0.3%/dexamethasone 0.1% and 7.95 for tobramycin 0.3%/loteprednol 0.5%. However, numerically greater reductions in symptom scores were observed after treatment among patients who had used the former combination product.

"If you used tobramycin 0.3%/dexamethasone 0.1% twice a day versus tobramycin 0.3%/loteprednol 0.5% twice a day, we found that tobramycin 0.3%/dexamethasone 0.1% was superior in terms of scores at decreasing the inflammation," Dr. Mah said. "The conclusion was that dexamethasone was a stronger steroid than loteprednol."

Mean post-treatment scores for tobramycin 0.3%/dexamethasone 0.1% and tobramycin 0.3%/loteprednol 0.5%, respectively, were: total ocular surface, 1.8 and 3.4 (p = 0.002); blepharitis, 0.9 and 1.35 (p = 0.017); discharge, 0.2 and 0.6 (p = 0.025); and conjunctivitis, 0.15 and 0.6 (p = 0.013). There was no significant difference between corneal PEK scores. The mean total ocular symptom scores for tobramycin 0.3%/dexamethasone 0.1% were statistically superior to those for tobramycin 0.3%/loteprednol 0.5% (1.80 versus 3.4, p = 0.002), Dr. Mah said.