Treatment of Acute Bacterial Conjunctivitis with Topical Lomefloxacin 0.3% Compared to Topical Ofloxacin 0.3%

Abstract

Purpose

The main purpose of this prospective study was to compare the efficacy, local tolerance, and safety of topical lomefloxacin 0.3% and topical ofloxacin 0.3% in the treatment of acute bacterial conjunctivitis.

Patients and Methods

Forty patients with acute bacterial conjunctivitis were included in a randomized, prospective, parallel-group study. Twenty patients were assigned to the lomefloxacin group (Okacin®, CIBA Vision Ophthalmics) and 20 patients to ofloxacin (Oflox®, Allergan). Lomefloxacin 0.3% was given 1 drop every 2 hours during waking hours on the first day then twice daily for one week. Ofloxacin 0.3% eyedrops were given four times daily. All patients underwent eye examination and clinical findings were graded and recorded according to severity of lid hyperemia, lid edema, lid crusting, conjunctival edema and discharge, bulbar conjunctival hyperemia, palpebral conjunctival hyperemia, corneal edema, and ocular discomfort. The score for each clinical sign was recorded before and after treatment. The mean cumulative sum score (CSS) was obtained by adding the scores for signs and symptoms. All conjunctival swabs were cultured and tested for sensitivity. Patients with confirmed bacterial conjunctivitis were included.

Results

There were 10 male and 10 female patients in each group. The age range was from 1 to 78 years, and the mean age was 35 years in the lomefloxacin group. In the ofloxacin group the age range was from 1 to 70 years, and the mean age was 26 years. There was no significant difference between the two groups in relation to age or sex. The causative organisms were Staphylococcus epidermidis in 16 cases (36%), α-hemolytic Streptococci in 9 (20%), Haemophilus spp. 6 (13%), Staphylococcus aureus 5 (11%), Streptococcus pneumoniae 4 (9%), Pseudomonas aeruginosa 3 (7%), and other 2 (4%). The mean CSS for conjunctivitis was 12.1 before therapy in the lomefloxacin group and 12.7 in the ofloxacin group. On the 7th day of therapy, the mean CSS was 0.7 in the lomefloxacin group, and 1.6 for ofloxacin. All patients showed improvement, but a total of 18 out of 20 (88%) in the lomefloxacin group showed complete resolution compared to 15 (75%) in the ofloxacin group. The difference was not statistically significant (p = 0.08). Tolerance was excellent in both groups, and no side effects were reported. A burning sensation was noted by two patients, one in each group.

Conclusions

Lomefloxacin and ofloxacin were equally effective and safe in the treatment of acute bacterial conjunctivitis.

Keywords

Acute conjunctivitis Bacterial conjunctivitis Fluoroquinolones Lomefloxacin Ofloxacin Quinolones

Get full access to this article

View all access options for this article.

References

Sanders

D.R.

, Aquavella

J.V.

, Hays

J.C.

, Jackson

W.B.

, Jensen

H.G.

, Long

D.A.

. New horizons in anti-infective therapy. Ocular Surgery News Supplement to May 1, 1990; 1–15.

Miller

I.M.

, Vogel

, Cook

R.T.J.

, Wittreich

, and the worldwide Nofloxacin Ophthalmic Trial Group. Topically administered Norfloxacin compared with topically administered Gentamicin for the treatment of external ocular bacterial infections. Am J Ophthalmol 1992; 113: 638–44.

Leibowitz

H.M.

. Antibacterial effectiveness of Ciprofloxacin 0.3% ophthalmic solution in the treatment of bacterial conjunctivitis. Am J Ophthalmol 1991; 112(suppl): S29–33.

Malminiemi

, Kari

, Latvala

M-L

, Voutilainen

, Miettinen

, Jauch

. Topical lomefloxacin twice daily compared with fucidic acid in acute bacterial conjunctivitis. Acta Ophthalmol Scand 1996; 74: 280–4.

Lesher

G.Y.

, Froelich

E.J.

, Gruett

M.D.

1,8-Naphthyridine derivatives: a new class of chemotherapeutic agents.

J Med Chem 1962; 5: 1063–5.

Fernandes

P.B.

. Mode of action and in vitro and in vivo activities of fluoroquinolones. J Clin Pharmacol 1998; 28: 156–68.

Cozzarelli

N.R.

. DNA gyrase and supercoiling of DNA. Science 1980; 207: 953–60.

Shen

L.L.

, Pernet

A.G.

. Mechanism of inhibition of DNA gyrase by analogues of nalidixic acid: The target of drugs is DNA. Proc Natl Acad Sci 1985; 82: 307–11.

Hirose

. Okezaki E, Kato H, Ito Y, Inoue M, Mitsuhashi S. In vitro and in vivo activity of NY-198, a new difluorinated quinolone. Antimicrob Agents Chemother 1987; 31: 854–9.

10.

E.Y.

, Trucksis

, Hooper

D.C.

. Quinolone resistance mutations in topoisomerase IV” Relationship to the flea locus and genetic evidence that topoisomerase IV is the primary target and DNA gyrase is the secondary target of fluoroquinolones in Staphylococcus aureus. Antimicrob Agents Chemother 1996; 40: 1881–8.

11.

Shen

L.L.

, Tanaka

S.K.

, Chu

D.T.W.

. Quinolones, 2-pyridones and resistant type II DNA topoisomerases. Curr Pharm Des 1997; 3: 169–76.

12.

Wise

, Andrews

J.M.

, Ashby

J.P.

, Matthews

R.S.

. In vitro activity of lomefloxacin, a new quinolone antimicrobial agent in comparison with those of other agents. Antimicrob Agents Chemother 1988; 32: 617–22.

13.

Chin

N-X

, Novelli

, Neu

H.C.

. In vitro activity of lomefloxacin (SC-47111; NY- 198), a difluoroquinolone 3-carboxylic acid, compared with those of other agents. Antimicrob Agents Chemother 1988; 32: 656–62.

14.

van der Auvera

, Grenier

, Giupezynski

, Pieranrd

. In vitro activity of lomefloxacin in comparison with perfloxacin and ofloxacin. J Antimicrob Chemother 1989; 23: 209–19.

15.

Inderlied

C.B.

, Lancero

M.G.

, Bermudez

L.M.

, Young

L.S.

. In vitro activity of lomefloxacin as compared with ciprofloxacin. Diagn Microbiol Infect Dis 1989; 12(suppl): S17–20.

16.

Stratton

C.W.

, Weeks

L.S.

. Bactericidal activity of lomefloxacin SC4711 (NY- 198) and ciprofloxacin against selected pathogens. Diagn Microbiol Infect Dis 1989; 12(suppl): 29S–34.

17.

Stone

J.W.

, Andrews

J.M.

, Ashby

J.P.

, Griggs

, Wise

. Pharmacokinetics and tissue penetration of orally administered lomefloxacin. Antimicrob Agents Chemother 1988; 32: 1508–10.

18.

Dette

G.A.

, Knothe

. In vitro evaluation of lomefloxacin. Arzneimittelforschung Drug Res 1989; 39: 832–5.

19.

Ooishi

, Oomomo

, Sakaue

Studies on intraocular penetration of NY198 (Lomefloxacin) eye drops.

Acta Soc Ophthalmol Jpn 1988; 92: 1825–32.

20.

Kam

K-M

, Lo

K-K

, Lai

C-F

, Lee

Y-S

, Chan

C-B

. Ofloxacin susceptibilities of 5,667 Neisseria gonorrheae strains isolated in Hong Kong. Antimicrob Agents Chemother 1993; 37: 2007–8.

21.

Smith

J.T.

, Lewin

C.S.

. Chemistry and mechanisms of action of the quinolone antibacterials. In: Andriole

V.T.

, ed. The Quinolones. London: Academic Press, 1988; 23–82.

22.

Wolfson

J.S.

, Hooper

D.C.

, Swartz

M.N.

. Mechanisms of action and resistance to quinolone antimicrobial agents. In: Wolfson

J.S.

, Hooper

D.C.

, eds. Quinolone antimicrobial agents. Washington: ASM, 1989; 5–34.

23.

Roskowski

, Ko

H.L.

, Roszkowski

, Ciborowski

, Jeljaszewics

, Pulverer

. Effects of ciprofloxacin on the humoral and cellular immune responses in Balb/C-mice. Zbl Bakt Hyg 1986; A262; 396–402.

24.

Forsgren

, Schlossman

S.F.

, Tedder

T.F.

. 4-Quinolone drugs affect cell cycle progression and function of human lymphocytes in vitro. Antimicrob Agents Chemother 1987; 31: 768–73.

25.

Roche

, Gougerot-pocidalo

M.A.

, Fay

, Etienne

, Forest

, Pocidalo

J.J.

. Comparative effects of quinolones on human mononuclear leukocyte functions. J Antimicrob Chemother 1987; 19: 781–90.

26.

Gollopudi

S.V.S.

, Prabhala

R.H.

, Thedepalli

. Effect of ciprofloxacin on mitogen stimulated lymphocyte proliferation. Antimicrob Agents Chemother 1986; 29: 337–8.

27.

Lombard

J.Y.

, Descotes

, Evreux

J.C.

. Polymorphonuclear leucocyte chemotaxis little affected by three quinolones in vitro. J Antimicrob Chemother 1987; 20: 614–5.

28.

Perea

E.J.

, Garcia

, Pascual

. Comparative penetration of lomefloxacin and other quinolones into human phagocytes. Am J Med 1992; 92(suppl): S48–51.

29.

Pruul

, McDonald

P.J.

. Lomefloxacin-induced modification of the kinetics of growth of Gram-negative bacteria and susceptibility to phagocytic killing by human neutrophils. J Antimicrob Chemother 1990; 25: 91–101.

30.

Jimenez

, Peman

, Canton

. Actividad Intrafagocitica Del Lemofloxacino. Rev Esp Quimioter 1994; 712: 142–5.

31.

Montero

, Casado

, Vigo

, Pastor

J.C.

, Alio

J.L.

, Soler

, Perea

, Escartin

, Jauch

. Treatment of patients with acute bacterial conjunctivitis with Lomefloxacin 0.3% b.i.d. or Gentamicin 0.3% b.i.d. Eur J Clin Research 1997.

32.

Wadworth

A.N.

, Goa

K.L.

. Lomefloxacin - a review of its antibacterial activity, pharmacokinetic properties, and therapeutic use. Drugs (Adis Int) 1991; 32: 1018–60.

33.

Yokota

, Suzuki

, Arai

. NY-198, a novel new quinolone, its in vitro antibacterial activity, cytotoxicity for mammalian cells, and synergy of bactericidal activity with mouse cultured macrophages. Chemotherapy 1988; 36(suppl): S25–35.

34.

Debbia

, Pesce

, Schito

G.C.

. In vitro assessment of the postantibiotic effect of Lomefloxacin against gram-positive and gram-negative pathogens. Am J Med 1992; 92(suppl): S45–7.

35.

Fukuda

, Chou

J.S.

, Sasaki

. Intraocular dynamic of a new antibacterial derivative of pyridone carboxylic acid (NY-198). Folia Ophthalmol Jpn 1989; 40: 72–6.

36.

Kodama

. Penetration of lomefloxacin ophthalmic solution (NY-198) into the human aqueous humor. Jpn Rev Ophthalmol 1991; 85: 493–5.

37.

Nos-Barbera

, Portoles

, Igual

, Fernandez-Piugcarbo

, Diez-Noguera

. A method to evaluate the activity of antimicrobial agents in a model of induced bacterial keratitis. Proceedings of the 8th International Society for Eye Research (ICER), San Francisco, USA. April 9, 1988; 5: 11.