Ocena skuteczności lewofloksacyny w leczeniu bakteryjnego zapalenia spojówek u niemowląt
Effectiveness of Levofloxacin Therapy in Bacterial Conjunctivitis in Infants
Szumiński Michał, Bakunowicz-Łazarczyk Alina, Sielicka Danuta
Department of Paediatric Ophthalmology with Strabismus Treatment Center of Medical University of Białystok,
Childrens University Hospital in Białystok
Head: Professor Alina Bakunowicz-Łazarczyk, M.D., Ph.D.
Summary: Aim: To evaluate bacteriology of mucopurulent discharge and response to monotherapy with 0.5% levofloxacin in conjunctivitis and congenital nasolacrimal duct obstruction in infants.
Patients and Methods: 154 samples from the conjunctival sac were obtained from 92 children with bacterial conjunctivitis, of which 35 also had nasolacrimal duct obstruction. The cultures were incubated and the infectious agents isolated. Children with simple conjunctivitis were treated with 0.5% levofloxacin Q2h for 2 days (except night hours) and then QID for 7 days. Control samples were taken 10 days after treatment initiation.
Results: Cultures were positive for bacteria from 140 samples (90.9%). 158 isolates of 9 different organisms were found. 140 Gram- -positive isolates were recovered, representing 88.6% of all isolates. The most common bacterial species was Streptococcus pneumonia, which accounted for 20.3% of all isolates. Gram-negative bacteria were recovered from 18 samples (11.4%). The predominant Gram- -negative bacterium was Hemophilus influenza. Monotherapy with levofloxacin was successful in 93.5%.
Conclusions: Bacterial conjunctivis, even associated with nasolacrimal duct obstruction can be managed with highest effectiveness with 0.5% levofloxacin.
Słowa kluczowe: bakteryjne zapalenie spojówek, lewofloksacyna, niemowlęta.
Keywords: bacterial conjunctivitis, levofloxacin, infants.
Conjunctivitis in small children is the most frequently
caused by bacterial infection. Typically it presents with moderate to severe
conjunctivitis and thick mucous-purulent discharge, which often is the most
copious in the morning. Bacterial conjunctivitis in children the most
frequently is caused by staphylococcal, streptococcal and Gram-negative bacilli
(1). Conjunctivitis course can be acute, supraacute or chronic. Acute
conjunctivitis at the begining is characterized by unilateral hyperaemia,
epiphora, conjunctival oedema oraz muco-purulent discharge. When the infection
is caused especially by streptococcus pseudo-membranes can be also present.
Supra-acute conjunctivitis (e.g. neisserhia gonorrhoe infection in infants) is
present with significant hemosis, and also palpebral oedema, and accumulation
of copious, green-yellowish discharge in conjunctival sac. Frequently,
coexisting periauricular lymph nodes enlargement is observed. Chronic
conjunctivitis is often of recurrent characteristics with periodical
exaccerbations. In newborns it can be associated with Chlamydia trachomatis
infection, in adolescents and adults more often is coexisting with blepharitis
of staphylococcal etiology.
What’s important, after many years of using that antibiotic
in clinical practice, no significant changes in bacterial susceptibility
responsible for conjuntivitis in children and adults were noted. Levofloxacin
eyedrops are characterized by good solubility, which ensures high antibiotic
concentration in the tear film (following 1 antibiotic drop administration
medicine concentration in tear film is above 2 mg/l for the next at least 6
hours) and in anterior chamber. It was additionaly shown, that levofloxacin is
characterized by low cytotoxicity to corneal cells and the least potent among
fluoroquinolones inhibiting wound healing process. Levofloxacin properties
listed and its’ high efficiency ensures good clinical effect of bacterial
conjunctivitis treatment in infants. No resistance development of the bacteria
the most commonly responsible for conjunctivitis entitles using levofloxacin as
the first line treatment. Levofloxain therapy limitation is such an issue, that
it requires frequent administration and systematic approach from parents.
Szaflik et al. study on levofloxacin efficiency administered TID and its’
safety in conjunctivitis treatment in adults showed good clinical response and
no differences comparing standard therapy (10). However, to give the answer to
the question: whether levofloxacin administration frequency reduction to 3
eyedrops daily influence bacterial resistance development and efficiency of the
treatment in infants, further clinical studies should be implemented.
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Fig. 1. Percentage of bacterial isolates responsible for