Prospective randomized comparison of 1-day versus 3-day application of topical levofloxacin in eliminating conjunctival flora.
OBJECTIVE
To compare efficacy of a 1-day versus 3-day application of topical levofloxacin in reducing ocular surface bacteria.


METHODS
In this prospective randomized controlled trial, 100 volunteer patients (50 per group) were assigned to receive topical 0.5% levofloxacin four times daily for 1 day or 3 days. Conjunctival cultures were obtained prior to (T0) and after the application of antibiotics (T1). Additionally, all patients received topical levofloxacin at 5-minute intervals for three applications (T2), followed by two drops of topical 5% povidone-iodine (T3). Conjunctival cultures were obtained at timepoints T2 and T3.


RESULTS
A 1-day application of topical levofloxacin significantly reduced (p = 0.0004) the number of eyes with positive conjunctival cultures from 41 eyes (82%) to 23 eyes (46%). Similarly, a 3-day application significantly reduced (p = 0.0001) the positive culture rate from 37 eyes (74%) to 17 eyes (34%). Two drops of povidone-iodine further reduced the positive culture rate for both groups to 20% (10 eyes for each group). There was no significant difference in positive culture rate between the 1-day and 3-day groups at T0 (p = 0.4689), T1 (p = 0.3074), T2 (p = 0.6706), or T3 (p = 1.000).


CONCLUSIONS
The application of topical 0.5% levofloxacin for 1 or 3 days significantly reduced the number of eyes with positive conjunctival cultures. The addition of 5% povidone-iodine further eliminated bacteria from the conjunctiva. The application of levofloxacin for 1 day appears to be as effective as a 3-day application.
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Department of Ophthalmology, School of Medicine, Stanford University, Stanford, California 94304, USA. cta@stanford.edu
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D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003228:Conjunctiva / Q000382:microbiology*; D009877:Endophthalmitis / Q000188:drug therapy* / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005500:Follow-Up Studies; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D064704:Levofloxacin; D008875:Middle Aged; D015242:Ofloxacin / Q000008:administration & dosage*; D009883:Ophthalmic Solutions; D011446:Prospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D009883:Ophthalmic Solutions; D064704:Levofloxacin; D015242:Ofloxacin