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

Purpose: to compare the efficacy of topical cefazolin-gentamicin versus vancomycin-ceftazidime for treatment of bacterial corneal ulcers. methods: 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. results: 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). conclusion: 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.