Cefazolin-Gentamicin versus Vancomycin-Ceftazidime Eye Drops for Bacterial Corneal Ulcers; a Randomized Clinical Trial

To compare the efficacy of topical cefazolin-gentamicin versus vancomycin-ceftazidime for treatment of bacterial corneal ulcers. This randomized double-masked clinical trial was performed on consecutive patients with bacterial corneal ulcers referred to Feiz Hospital, Isfahan, Iran from 2004 to 2005. Patients were randomly assigned to cefazolin-gentamicin or vancomycin-ceftazidime eye drops in a masked fashion. Outcome measures included time for resolution of stromal infiltration, re-epithelization of the epithelial defect, and clearance of anterior chamber inflammation as well as culture results and complications. The study included 89 eyes of 89 patients with bacterial corneal ulcers consisting of 57 (64%) male and 32 (36%) female subjects. Specimens were culture-negative in 46% of cases. Forty-one eyes received cefazolin-gentamicin and 48 eyes were treated with vancomycin-ceftazidime. Time for resolution of stromal infiltration was 17.7±4.3 days versus 13.8±3.6 days (P=0.04), time to complete re-epithelization was 13.2±3.1 days versus 9.6±2.7 days (P=0.01) and time for clearing of the anterior chamber was 11.6±2.9 days versus 8.1±2.3 days (P=0.04) in the cefazolin-gentamicin and vancomycin-ceftazidime groups, respectively. The most common complaint related to the medications was ocular burning in 73.1% of patients treated with cefazolin-gentamicin and 62.9% of cases receiving vancomycin-ceftazidime (P=0.007). Vancomycin-ceftazidime eye drops seem to be more effective than cefazolin-gentamicin eye drops for the treatment of bacterial corneal ulcers and are probably better tolerated locally.