Topical antibiotics for treating bacterial keratitis: a network meta-analysis.

Area of Science:

• Ophthalmology
• Infectious Diseases
• Pharmacology

Background:

• Infectious keratitis, particularly bacterial keratitis (BK), is a leading cause of preventable blindness globally.
• Prompt diagnosis and treatment are crucial to prevent corneal scarring and vision loss.
• Optimal topical antibiotic choice for BK remains uncertain due to clinical practice variations.

Purpose of the Study:

• To systematically review and perform a network meta-analysis (NMA) of randomized controlled trials (RCTs).
• To compare the benefits and harms of various topical antibiotics for treating BK.
• To rank interventions based on efficacy and safety.

Main Methods:

• Searched multiple databases (CENTRAL, MEDLINE, Embase) and trial registries up to August 2024.
• Included 23 RCTs with 2692 participants diagnosed with BK.
• Assessed outcomes including healing time, visual acuity, and adverse effects; used RoB 2 and CINeMA tools.

Main Results:

• Vancomycin + ceftazidime, moxifloxacin, and cefazolin + tobramycin demonstrated the fastest corneal healing times.
• Moxifloxacin, vancomycin + ceftazidime, and cefazolin + tobramycin showed faster healing than ciprofloxacin monotherapy.
• Vancomycin + ceftazidime was associated with the fewest non-serious harms.

Conclusions:

• Vancomycin + ceftazidime, moxifloxacin, and cefazolin + tobramycin appear most effective for BK healing.
• Ciprofloxacin monotherapy was the least effective treatment.
• The certainty of evidence is mostly moderate to very low, necessitating cautious interpretation and further research.