0.3% ciprofloxacin ophthalmic ointment in the treatment of bacterial keratitis. The Ciprofloxacin Ointment/Bacterial Keratitis Study Group.

OBJECTIVE: To determine the efficacy and safety of topical 0.3% ciprofloxacin hydrochloride ophthalmic ointment in the treatment of bacterial keratitis. DESIGN: Prospective case series with a nonrandomized comparison of culture-positive, evaluable cases (ciprofloxacin ointment group) with culture-positive, concurrent patients (nonenrolled group) treated with conventional therapy. SETTING: Multicenter clinical study. PATIENTS: After informed consent was obtained, 253 eligible patients underwent corneal scrapings and received topical ciprofloxacin ointment; 145 (57%) had positive cultures and completed the follow-up schedule. Forty (70%) of 57 apparently eligible patients had culture-positive bacterial keratitis but were not enrolled in the ciprofloxacin ointment study during the same period. INTERVENTION: Ciprofloxacin ophthalmic ointment instilled every 1 to 2 hours for 2 days, then every 4 hours for 12 days. MAIN OUTCOME MEASURES: Clinical evaluation of signs at 1, 3, 7, and 14 days of treatment and the overall condition classified as clinical success (cured or improved) or failure (unchanged or worse) during and after therapy. RESULTS: Clinical success with the initial treatment occurred in 135 patients (93%) in the ciprofloxacin ointment group and in 28 patients (70%) in the nonenrolled group. Of the 10 ciprofloxacin clinical failures, seven were staphylococcal; two, pneumococcal; and one, polybacterial. The 90% minimum inhibitory concentration of ciprofloxacin was 3 mg/L or less for corneal bacterial isolates. No serious adverse event attributable to ciprofloxacin ointment occurred, although 32 (13%) of 253 patients developed a transient white crystalline corneal precipitate shown with liquid chromatography in two cases to be ciprofloxacin. CONCLUSION: Ciprofloxacin ophthalmic ointment is an effective and safe topical antimicrobial agent for the treatment of bacterial keratitis caused by susceptible microorganisms.

Mycobacterium gordonae infection of the hand.

A 70-year-old woman was seen for two chronic nodules on the dorsum of her left hand. They had a uniquely mamillated surface, but histopathologically showed nonspecific granulomatous changes with no organisms seen. Laboratory studies disclosed the lesions were due to Mycobacterium gordonae, an organism commonly ignored as a pathogen. The histopathologic changes were reproduced by intradermal testing with tuberculin. The lesions, unaffected by ketoconazole, as well as by a variety of antibiotics, including minocycline hydrochloride, slowly involuted during a one-year period. To our knowledge, this patient is the first documented case of cutaneous infection from this organism. Mycobacterium gordonae must be added to the list of true mycobacterial pathogens.

The effectiveness of two ciprofloxacin formulations for experimental Pseudomonas and Staphylococcus keratitis.

Ciprofloxacin is a fluoroquinolone antibiotic with broad spectrum bactericidal activity. A commercially available form of ciprofloxacin contains benzalkonium chloride (BAC) (0.006%) and EDTA (0.05%) as preservatives. Since BAC has been shown to cause adverse changes in corneal epithelial cells, a formulation of ciprofloxacin devoid of BAC and EDTA but with the same effectiveness would be valuable. We present here the results of experiments designed to assess the efficacy of a BAC-free and EDTA-free formulation of ciprofloxacin, Ciprofloxacin-polystyrene sulfonate (PSS), in experimental models of Pseudomonas aeruginosa and Staphylococcus aureus keratitis. Both formulations of ciprofloxacin sterilized corneas infected with P aeruginosa, and both formulations showed equal bactericidal activity for S aureus. Normal eyes treated with either formulation showed mild conjunctival irritation compared to untreated normal eyes. The bactericidal activities of both formulations of ciprofloxacin were excellent. Therefore, the Ciprofloxacin-PSS formulation could serve as an effective single drug therapy for ocular infections.