Early addition of topical corticosteroids in the treatment of bacterial keratitis
IMPORTANCE: Scarring from bacterial keratitis remains a leading cause of visual loss.
OBJECTIVE: To determine whether topical corticosteroids are beneficial as an adjunctive therapy for bacterial keratitis if given early in the course of infection.
DESIGN, SETTING, AND PARTICIPANTS: The Steroids for Corneal Ulcers Trial (SCUT) was a randomized, double-masked, placebo-controlled trial that overall found no effect of adding topical corticosteroids to topical moxifloxacin hydrochloride in bacterial keratitis. Here, we assess the timing of administration of corticosteroids in a subgroup analysis of the SCUT. We define earlier administration of corticosteroids (vs placebo) as addition after 2 to 3 days of topical antibiotics and later as addition after 4 or more days of topical antibiotics.
MAIN OUTCOMES AND MEASURES: We assess the effect of topical corticosteroids (vs placebo) on 3-month best spectacle-corrected visual acuity in patients who received corticosteroids or placebo earlier vs later. Further analyses were performed for subgroups of patients with non-Nocardia keratitis and those with no topical antibiotic use before enrollment.
RESULTS: Patients treated with topical corticosteroids as adjunctive therapy within 2 to 3 days of antibiotic therapy had approximately 1-line better visual acuity at 3 months than did those given placebo (-0.11 logMAR; 95% CI, -0.20 to -0.02 logMAR; P = .01). In patients who had 4 or more days of antibiotic therapy before corticosteroid treatment, the effect was not significant; patients given corticosteroids had 1-line worse visual acuity at 3 months compared with those in the placebo group (0.10 logMAR; 95% CI, -0.02 to 0.23 logMAR; P = .14). Patients with non-Nocardia keratitis and those having no topical antibiotic use before the SCUT enrollment showed significant improvement in best spectacle-corrected visual acuity at 3 months if corticosteroids were administered earlier rather than later.
CONCLUSIONS AND RELEVANCE: There may be a benefit with adjunctive topical corticosteroids if application occurs earlier in the course of bacterial corneal ulcers.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2014 |
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| Erschienen: |
2014 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:132 |
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| Enthalten in: |
JAMA ophthalmology - 132(2014), 6 vom: 28. Juni, Seite 737-41 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ray, Kathryn J [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 18.08.2014 Date Revised 21.10.2021 published: Print Citation Status MEDLINE |
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| doi: |
10.1001/jamaophthalmol.2014.292 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM23766321X |
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| 100 | 1 | |a Ray, Kathryn J |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Early addition of topical corticosteroids in the treatment of bacterial keratitis |
| 264 | 1 | |c 2014 | |
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| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 18.08.2014 | ||
| 500 | |a Date Revised 21.10.2021 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a IMPORTANCE: Scarring from bacterial keratitis remains a leading cause of visual loss | ||
| 520 | |a OBJECTIVE: To determine whether topical corticosteroids are beneficial as an adjunctive therapy for bacterial keratitis if given early in the course of infection | ||
| 520 | |a DESIGN, SETTING, AND PARTICIPANTS: The Steroids for Corneal Ulcers Trial (SCUT) was a randomized, double-masked, placebo-controlled trial that overall found no effect of adding topical corticosteroids to topical moxifloxacin hydrochloride in bacterial keratitis. Here, we assess the timing of administration of corticosteroids in a subgroup analysis of the SCUT. We define earlier administration of corticosteroids (vs placebo) as addition after 2 to 3 days of topical antibiotics and later as addition after 4 or more days of topical antibiotics | ||
| 520 | |a MAIN OUTCOMES AND MEASURES: We assess the effect of topical corticosteroids (vs placebo) on 3-month best spectacle-corrected visual acuity in patients who received corticosteroids or placebo earlier vs later. Further analyses were performed for subgroups of patients with non-Nocardia keratitis and those with no topical antibiotic use before enrollment | ||
| 520 | |a RESULTS: Patients treated with topical corticosteroids as adjunctive therapy within 2 to 3 days of antibiotic therapy had approximately 1-line better visual acuity at 3 months than did those given placebo (-0.11 logMAR; 95% CI, -0.20 to -0.02 logMAR; P = .01). In patients who had 4 or more days of antibiotic therapy before corticosteroid treatment, the effect was not significant; patients given corticosteroids had 1-line worse visual acuity at 3 months compared with those in the placebo group (0.10 logMAR; 95% CI, -0.02 to 0.23 logMAR; P = .14). Patients with non-Nocardia keratitis and those having no topical antibiotic use before the SCUT enrollment showed significant improvement in best spectacle-corrected visual acuity at 3 months if corticosteroids were administered earlier rather than later | ||
| 520 | |a CONCLUSIONS AND RELEVANCE: There may be a benefit with adjunctive topical corticosteroids if application occurs earlier in the course of bacterial corneal ulcers | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
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| 650 | 7 | |a Quinolines |2 NLM | |
| 650 | 7 | |a Prednisolone |2 NLM | |
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| 650 | 7 | |a Moxifloxacin |2 NLM | |
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| 700 | 1 | |a Srinivasan, Muthiah |e verfasserin |4 aut | |
| 700 | 1 | |a Mascarenhas, Jeena |e verfasserin |4 aut | |
| 700 | 1 | |a Rajaraman, Revathi |e verfasserin |4 aut | |
| 700 | 1 | |a Ravindran, Meenakshi |e verfasserin |4 aut | |
| 700 | 1 | |a Glidden, David V |e verfasserin |4 aut | |
| 700 | 1 | |a Oldenburg, Catherine E |e verfasserin |4 aut | |
| 700 | 1 | |a Sun, Catherine Q |e verfasserin |4 aut | |
| 700 | 1 | |a Zegans, Michael E |e verfasserin |4 aut | |
| 700 | 1 | |a McLeod, Stephen D |e verfasserin |4 aut | |
| 700 | 1 | |a Acharya, Nisha R |e verfasserin |4 aut | |
| 700 | 1 | |a Lietman, Thomas M |e verfasserin |4 aut | |
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