Indecision about corticosteroids for bacterial keratitis: an evidence-based update.

Authors

Wilhelmus KR 

Institution

Sid W. Richardson Ocular Microbiology Laboratory, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.

Source

Ophthalmology 2002 May; 109(5) :835-42; quiz 843.

Abstract

PURPOSE
To quantify the effect of topical corticosteroids on bacterial keratitis.
CLINICAL RELEVANCE
Bacterial keratitis is an economically important infection affecting 1 in 10,000 Americans annually. The predisposing factors, prior ocular health, infecting microorganisms, inflammatory severity, and therapeutic choices can affect the course and outcome. Antibacterial treatment is often curative but does not guarantee good vision. Because many treated patients develop a sight-limiting corneal problem, antiinflammatory therapy has sometimes been recommended. LITERATURE REVIEWED: Publications from 1950 to 2000 that evaluated the effect of corticosteroids on bacterial keratitis in animal experiments, case reports and series, case-comparison and cohort studies, and clinical trials were systematically identified by electronic and manual search strategies.
RESULTS
The use of a topical corticosteroid before the diagnosis of bacterial keratitis significantly predisposed to ulcerative keratitis in eyes with preexisting corneal disease (odds ratio [OR], 2.63; 95% confidence limits [CL], 1.41, 4.91). Once microbial keratitis occurred, prior corticosteroid use significantly increased the odds of antibiotic treatment failure or other infectious complications (OR, 3.75; 95% CL, 2.52, 5.58). However, the effect of a topical corticosteroid with antibiotics after the onset of bacterial keratitis was unclear. Experimental models suggested likely advantages, but clinical studies did not show a significant effect of topical corticosteroid therapy on the outcome of bacterial keratitis (OR, 0.62; 95% CL, 0.25, 1.54).
CONCLUSIONS
Topical corticosteroids increase the risk of infectious complications affecting the cornea but may or may not have an effect during antibacterial therapy. The unproven role of corticosteroids in the adjunctive treatment of bacterial keratitis highlights the need to collect prospective information that would guide appropriate management for this common eye disease.

Mesh

Administration, Topical
Animals
Anti-Infective Agents, Local
Anti-Inflammatory Agents
Clinical Trials as Topic
Evidence-Based Medicine
Eye Infections, Bacterial
Glucocorticoids
Humans
Keratitis
Treatment Failure

Language

eng

Pub Type(s)

Journal Article Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. Review

PubMed ID

11986084