A controlled trial of povidone-iodine to treat infectious conjunctivitis in children.
OBJECTIVE
To report the efficacy of povidone-iodine as a treatment for conjunctivitis in pediatric patients.


METHODS
Double-masked, controlled, prospective clinical trial.


METHODS
In an ophthalmology clinic in a general hospital in Manila, Philippines, 459 children (mean [SD] age 6.6 [6.6] years; range, 7 months-21 years) with acute conjunctivitis were studied. Infected eyes were cultured for bacteria and underwent immunofluorescent testing for Chlamydia trachomatis. Viral conjunctivitis was diagnosed if bacterial cultures were negative and diagnostic criteria were met. Subjects were alternated to receive povidone-iodine 1.25% or neomycin-polymyxin-B-gramicidin ophthalmic solution, one drop 4 times daily in the affected eye. Ocular inflammation was evaluated daily by the family or patient and weekly by an ophthalmologist. The main outcome measures were days until cured and proportion cured after 1 and 2 weeks of treatment.


RESULTS
Despite adequate statistical power (power >80% for a 1-day difference and P <.05), there was no significant difference between treatment groups regarding the number of days to cure or proportion cured at 1 or 2 weeks whether caused by bacteria or virus (P =.133-.824 for the four comparisons). After 1 week of treatment, povidone-iodine cured marginally more chlamydial infections than the antibiotic (P =.057). By 2 weeks, fewer chlamydial infections were cured than those of viral or bacterial etiology (P =.0001). The younger the patient, the faster their conjunctivitis resolved (R = 0.13, P =.013).


CONCLUSIONS
Povidone-iodine 1.25% ophthalmic solution was as effective as neomycin-polymyxin B-gramicidin for treating bacterial conjunctivitis, somewhat more effective against chlamydia, and as ineffective against viral conjunctivitis. Povidone-iodine ophthalmic solution should be strongly considered as treatment for bacterial and chlamydial conjunctivitis, especially in developing countries where topical antibiotics are often unavailable or costly.
Isenberg
Sherwin J
SJ
Jules Stein Eye Institute, Department of Ophthalmology, Harbor/UCLA Medical Center, UCLA School of Medicine, Los Angeles, California, and, Torrance, California 90509, USA. isenberg@ucla.edu
Apt
Leonard
L
Valenton
Mario
M
Del Signore
Madeline
M
Cubillan
Leo
L
Labrador
Maria A
MA
Chan
Pauline
P
Berman
Nancy G
NG
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001419:Bacteria / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D003228:Conjunctiva / Q000382:microbiology / Q000821:virology; D003234:Conjunctivitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D003236:Conjunctivitis, Viral / Q000188:drug therapy* / Q000821:virology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006096:Gramicidin / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D009355:Neomycin / Q000627:therapeutic use; D009883:Ophthalmic Solutions; D011112:Polymyxin B / Q000627:therapeutic use; D011206:Povidone-Iodine / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome; D014780:Viruses / Q000302:isolation & purification
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D009883:Ophthalmic Solutions; D006096:Gramicidin; D011206:Povidone-Iodine; D009355:Neomycin; D011112:Polymyxin B