title: Prospective, Randomized Clinical Trial of Povidone-Iodine 1.25% Solution Versus Topical Antibiotics for Treatment of Bacterial Keratitis.
abstract: OBJECTIVE
  To compare povidone-iodine 1.25% ophthalmic solution with topical antibiotics for treatment of bacterial keratitis in areas of the world where use of effective topical antibiotics may not be an option.
  
  
  METHODS
  Randomized, controlled, investigator-masked clinical trial.
  
  
  METHODS
  We randomized 172 individuals with bacterial keratitis to topical treatment with povidone-iodine or antibiotics (neomycin-polymyxin B-gramicidin in the Philippines; ciprofloxacin 0.3% in India). Using survival analysis, we compared intervals from start of treatment to "presumed cure" (primary outcome measure, defined as a closed epithelial defect without associated inflammatory signs) and to "recovering" (residual epithelial defect <1 mm2with only minimal inflammation).
  
  
  RESULTS
  Median interval to presumed cure in the Philippines was 7 days for povidone-iodine and 7 days for neomycin-polymyxin B-gramicidin (95% confidence interval [CI] for difference in median interval, -9.5 to 0.7 days) and in India was 12 days for povidone-iodine and 17 days for ciprofloxacin (95% CI, -35.2 to 3.2 days). Hazard ratio (HR) for presumed cure among those treated with povidone-iodine (vs antibiotics) was 1.46 in the Philippines (95% CI, 0.90-2.36; P = .13) and 1.70 in India (95% CI, 0.73-3.94; P = .22). Comparisons of intervals to recovering and HR for recovering also revealed no significant differences between treatment groups in either country.
  
  
  CONCLUSIONS
  There is no significant difference between the effect of topical povidone-iodine 1.25% and topical antibiotics commonly available in the developing world for treatment of bacterial keratitis. Povidone-iodine 1.25%, which is widely available and inexpensive, can be considered for treatment of bacterial keratitis when antibiotic treatment is not practical.
authors.affiliation: Center To Prevent Childhood Blindness, UCLA Stein Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.
authors.forename: Sherwin J
authors.initials: SJ
authors.lastname: Isenberg
authors.affiliation: Center To Prevent Childhood Blindness, UCLA Stein Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Leonard
authors.initials: L
authors.lastname: Apt
authors.affiliation: Philippine General Hospital, Manila, Philippines.
authors.forename: Mario
authors.initials: M
authors.lastname: Valenton
authors.affiliation: L.V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Savitri
authors.initials: S
authors.lastname: Sharma
authors.affiliation: L.V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Prashant
authors.initials: P
authors.lastname: Garg
authors.affiliation: Joseph Eye Hospital, Tiruchirapalli, India.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Thomas
authors.affiliation: Joseph Eye Hospital, Tiruchirapalli, India.
authors.forename: Pragya
authors.initials: P
authors.lastname: Parmar
authors.affiliation: Joseph Eye Hospital, Tiruchirapalli, India.
authors.forename: Jayaraman
authors.initials: J
authors.lastname: Kaliamurthy
authors.affiliation: Philippine General Hospital, Manila, Philippines.
authors.forename: Johann M
authors.initials: JM
authors.lastname: Reyes
authors.affiliation: Philippine General Hospital, Manila, Philippines.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ong
authors.affiliation: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Christenson
authors.affiliation: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.
authors.forename: Madeline
authors.initials: M
authors.lastname: Del Signore
authors.affiliation: Ocular Inflammatory Disease Center, UCLA Stein Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California. Electronic address: uveitis@jsei.ucla.edu.
authors.forename: Gary N
authors.initials: GN
authors.lastname: Holland
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D015818:Eye Infections, Bacterial / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007634:Keratitis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011206:Povidone-Iodine / Q000008:administration & dosage*; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D004338:Drug Combinations; D011206:Povidone-Iodine