Editorial

Moxifloxacin Versus Polymyxin B/Trimethoprim Sulfate in Pediatric Bacterial Conjunctivitis

he clinical impression of many of the pediatric ophthalmologists who treat bacterial conjunctivitis in children is that the more recently introduced fluoroquinolones, gatifloxacin and moxifloxacin, are more effective than older topical antibiotics. These clinical observations are primarily supported by studies citing in vitro data only. Up to this point, the science to confirm the efficacy of these antibiotics was based on the demonstration of rapid and effective bacterial eradication and the logical projection of a more rapid clinical response and subsequent reduction in contagiousness. Skeptics might correctly state that practice patterns should only be changed following clinical studies that demonstrate superiority with a particular therapy. With the publication of the article by Granet et al. in this issue comparing the treatment of pediatric bacterial conjunctivitis using topical polymyxin B sulfate/trimethoprim versus moxifloxacin, new clinical data are available and the results are impressive. At 48 hours following the initiation of therapy in culture-positive eyes, complete resolution of ocular signs and symptoms was observed in 81% of the children treated with moxifloxacin and in only 44% of those treated with the combination of polymyxin/trimethoprim. Furthermore, moxifloxacin had a 100% eradication of Streptococcus pneumoniae at 48 hours versus 50% for polymyxin/trimethoprim. This is significant because this organism is one of the primary pathogens causing conjunctivitis in children. The authors proceed to calculate the socioeconomic benefits of early cure, citing factors such as a reduction in loss of school funding due to absenteeism and other indirect costs. The opportunity to reduce the duration of this self-limited disease from 5 or 7 days to 48 hours or less cannot be overlooked. The authors are to be commended for undertaking this head-to-head study, which confirms with clinical data what many of us suspected or observed in our patients treated with moxifloxacin. The authors comment that this was an exploratory study with 84 eyes in 56 patients and that they plan to undertake a future study with a larger number of subjects. Rudolph S. Wagner, MD Editor

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November/December 2008/vol 45 No 6