Corneal ciprofloxacin precipitation during bacterial keratitis.
Corneal ciprofloxacin precipitation during bacterial keratitis.
复制标题
细菌性角膜炎期间角膜环丙沙星沉淀。
DOI：
10.1016/s0002-9394(03)00636-6
复制
发表时间：
2003
影响因子：
4.2
通讯作者：
Abshire,RobertL
中科院分区：
文献类型：
--
作者：
Wilhelmus,KirkR;Abshire,RobertL
目的观察年龄对环丙沙星治疗细菌性角膜炎时发生白色角膜沉淀物的风险的影响，并探讨白色沉淀物对临床改善率和治愈率的影响。设计前瞻性、多中心、观察性队列研究。方法对624例局部应用0.3%环丙沙星溶液或软膏的细菌性角膜炎患者进行角膜表面白色沉淀物的记录。根据年龄分类和其他临床特征的Logistic回归分析，估计角膜沉着的相对风险。结果55例(15.2%)患者在环丙沙星治疗期间出现白色角膜沉淀物；72例(75.8%)患者在治疗前3天内开始出现白色角膜沉淀物。与40岁以下患者相比，60~69岁患者发生环丙沙星沉淀的风险是2.8倍(95%可信区间，1.9，3.9)；70岁以上患者发生环丙沙星沉淀的风险是3.7倍(95%可信区间，2.6，5.0)。可见角膜沉淀物的中位持续时间为8.5天(90%，32天)。环丙沙星沉淀对疗效改善的时间无显著影响(P=0.09)，但使再上皮化时间延长55%(95%CL 32%，70%)。结论局部应用环丙沙星治疗细菌性角膜炎患者角膜沉积的风险较高。白色沉淀物显然不会干扰抗菌治疗反应，但可能会延迟溃疡性角膜炎的上皮愈合。
PURPOSETo examine how age affects the risk of developing a white corneal precipitate during ciprofloxacin therapy for bacterial keratitis and to explore the effect of a white precipitate on rates of clinical improvement and cure.DESIGNProspective, multicenter, observational cohort study.METHODSOccurrence of a white precipitate of the corneal surface was recorded among 624 patients with presumed bacterial keratitis who were treated with topical ciprofloxacin 0.3% solution or ointment. Relative risks of corneal precipitation were estimated from logistic regression for age categories and other clinical characteristics. The time-dependent effects of precipitate on rates of infection resolution and corneal reepithelialization were estimated by proportional hazards regression.RESULTSNinety-five (15.2%) patients developed a white corneal precipitate during ciprofloxacin therapy; 72 (75.8%) began within the first 3 days of treatment. Compared with those younger than 40 years old, patients aged 60 to 69 years had 2.8 (95% confidence limits [CL], 1.9, 3.9) times the risk of ciprofloxacin precipitation; patients 70 years and older had 3.7 (95% CL, 2.6, 5.0) times the risk. Median duration of the visible corneal precipitate was 8.5 days (90% decile, 32 days). Presence of ciprofloxacin precipitation did not significantly affect the time until therapeutic improvement (P = .09) but slowed the time until reepithelialization by 55% (95% CL 32%, 70%).CONCLUSIONSOlder patients treated with topical ciprofloxacin for bacterial keratitis have a higher risk of corneal deposition. A white precipitate apparently does not interfere with antibacterial therapeutic response but may delay epithelial healing of ulcerative keratitis.