Cefazolin-Gentamicin versus Vancomycin-Ceftazidime Eye Drops for Bacterial Corneal Ulcers;a Randomized Clinical Trial

PURPOSE: To compare the efficacy of topical cefazolin-gentamicin versus vancomycinceftazidime for treatment of bacterial corneal ulcers. METHODS: This randomized double-masked clinical trial was performed on consecutive patients with bacterial corneal ulcers referred to Feiz Hospital, Isfahan, Iran from 2004 to 2005. Patients were randomly assigned to cefazolin-gentamicin or vancomycin-ceftazidime eye drops in a masked fashion. Outcome measures included time for resolution of stromal infiltration, re-epithelization of the epithelial defect, and clearance of anterior chamber inflammation as well as culture results and complications. RESULTS: The study included 89 eyes of 89 patients with bacterial corneal ulcers consisting of 57 (64%) male and 32 (36%) female subjects. Specimens were culturenegative in 46% of cases. Forty-one eyes received cefazolin-gentamicin and 48 eyes were treated with vancomycin-ceftazidime. Time for resolution of stromal infiltration was 17.7± 4.3 days versus 13.8± 3.6 days (P=0.04), time to complete re-epithelization was 13.2± 3.1 days versus 9.6± 2.7 days (P=0.01) and time for clearing of the anterior chamber was 11.6± 2.9 days versus 8.1± 2.3 days (P=0.04) in the cefazolin-gentamicin and vancomycin-ceftazidime groups, respectively. The most common complaint related to the medications was ocular burning in 73.1% of patients treated with cefazolingentamicin and 62.9% of cases receiving vancomycin-ceftazidime (P=0.007). CONCLUSION: Vancomycin-ceftazidime eye drops seem to be more effective than cefazolin-gentamicin eye drops for the treatment of bacterial corneal ulcers and are probably better tolerated locally.