title: Natamycin in the treatment of fungal keratitis: a systematic review and Meta-analysis.
abstract: OBJECTIVE
  To review published clinical studies examining the effect of natamycin in the treatment of fungal keratitis.
  
  
  METHODS
  We selected the publications in CENTRAL, MEDLINE, EMBASE, CNKI, and CBM. This study systematically reviewed published randomized controlled trials (RCTs) that compared natamycin to other antifungal agents, and conducted feasible Meta-analysis of efficacy results using Revman 5.2 software.
  
  
  RESULTS
  We included seven trials which were mainly carried out in developing countries of Asia, with five trials conducted in India, one each in China and Bangladesh. A total of 804 participants were randomized to following comparisons: 2% econazole versus 5% natamycin showed little difference in the effects of treatment of fungal keratitis [RR=0.99, 95% confidence interval (CI), 0.8 to 1.21]; chlorhexidine gluconate versus 5% natamycin indicated that the results on healing of the ulcer at 21d was less conclusive (RR=0.77, 95% CI, 0.55 to 1.08; I (2)=0%); 1% voriconazole versus 5% natamycin suggested that natamycin treatment appeared to be significantly better outcomes than voriconazole (regression coefficient =-0.18 logMAR; 95% CI, -0.30 to -0.05; P=0.006), especially in Fusarium cases (regression coefficient=-0.41 logMAR; 95% CI, -0.61 to -0.20; P<0.001); natamycin versus fluconazole showed a significant difference in cure rate (χ(2)=5.048, P<0.05) and natamycin group was more effective than fluconazole in average period of therapy (t=7.94, P<0.01).
  
  
  CONCLUSIONS
  Natamycin was a preferable choice in the treatment of fungal keratitis, especially in the early period of Fusarium cases.
authors.affiliation: Department of Ophthalmology, Medical College, Qingdao University, Qingdao 266071, Shandong Province, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Qiu
authors.affiliation: Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China.
authors.forename: Gui-Qiu
authors.initials: GQ
authors.lastname: Zhao
authors.affiliation: Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Ophthalmology, Medical College, Qingdao University, Qingdao 266071, Shandong Province, China.
authors.forename: Xue
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China.
authors.forename: Li-Ting
authors.initials: LT
authors.lastname: Hu
authors.affiliation: Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China.
authors.forename: Zhao-Dong
authors.initials: ZD
authors.lastname: Du
authors.affiliation: Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Ophthalmology, Medical College, Qingdao University, Qingdao 266071, Shandong Province, China.
authors.forename: Cheng-Cheng
authors.initials: CC
authors.lastname: Zhu
keywords: Meta-analysis; eye infection; fungal; natamycin