This article is more than 5 years old. Information may no longer be current.
How to choose the drug you use
Ofloxacin or ciprofloxacin? Fluoroquinolones are so effective that either choice is a smart one.
Click Here to Manage Email Alerts
Surgeons have an abundance of studies to consult when deciding which topical ophthalmic fluoroquinolone to use, but many wonder whether the choice is a clinically significant one.
The differences found between ciprofloxacin (Ciloxan; Alcon) and ofloxacin (Ocuflox; Allergan) in the lab might make little or no difference in everyday use, some surgeons said. The drugs have varying properties in vitro, to be sure, and these differences are spelled out at scientific meetings and in literature in great detail. But in vivo, surgeons have taken to picking up the bottles out of habit or in response to a pharmaceutical representative’s sales call. The fact that users of both drugs have excellent clinical results is a testament to the power of the fluoroquinolones as a drug class.
Both work well
According to Kenneth R. Kenyon, MD, of the debate between ciprofloxacin and ofloxacin, “My sense is that it almost invariably does not make a difference.”
He continued to say that, “If one adapts a conservative clinical management style, uses prophylactic antibiotics at the appropriate dosage for at least 1 or 2 days preoperatively and three to four times per day preoperative dosing … then the two drugs in question have great clinical equivalency.”
Still, many surgeons do prefer one drug over another for one reason or another. The three main questions are:
- Does it work? The issues include prophylaxis, kill curves and the minimum inhibitory concentration.
- Does it get to where it has to go? Debate points include penetration and intraocular drug levels.
- Are the above two points clinically significant? This is what physicians need to consider, Dr. Kenyon said.
“One has to walk the appropriate line when recommending one commercial source over another,” he said. “Drug manufacturers have their own and often scientifically-based bias that is hard to translate into a distinctive advantage vis-à-vis clinical practice.”
According to Michael A. Lemp, MD, “I know that there are theoretical differences why people prefer one over the other and it is a big campaign. There’s this tremendous competition between the two [companies] for the antibiotic market.”
Most clinicians are creatures of habit, and will stick with one quinolone for all uses after finding that one works well.
“Ciloxan was on the market first, so we had experience with Ciloxan. It’s a good antibiotic,” he said.
Still, Dr. Lemp said, “There’s no question about it, they both work well. They have broad spectrum coverage. You could make a case for either of them. But I don’t think that you can make a case that one is obviously superior clinically to the other.”
Dr. Kenyon said that he uses either drug, largely out of convenience.
“It is largely a question of what center I am working in, what is the current cost situation, and the fact that I truly consider them to be clinically equivalent drugs,” he said. “I attribute any strong feelings on that subject to be more dictated by medical economics and contract-driven convenience than by anything else.”
Ocular Surgery News examined the differences between ciprofloxacin and ofloxacin by addressing surface prophylaxis, corneal penetration and clinical results. The series draws upon lectures presented at the Hawaii 2000 meeting, sponsored by Ocular Surgery News and the New England Eye Center, as well as interviews with leading corneal experts.
For Your Information:
- Kenneth R. Kenyon, MD, can be reached at Corneal Consultants, 100 Charles River Plaza, Ste. 301, Boston, MA 02114; (617) 523-2010; fax: (617) 523-4242; e-mail: kkenyon@compuserve.com. Dr. Kenyon has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
- Michael A. Lemp, MD, can be reached at University Ophthalmology Consultants, 4910 Massachusetts Ave. NW, Ste. 210, Washington, DC 20016; (202) 686-6800; fax: (202) 686-6668. Dr. Lemp has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
- Alcon can be reached at 6201 South Freeway, Fort Worth, TX 76134; (800) 862-5266; fax: (817) 241-0677.
- Allergan can be reached at 2525 Dupont Drive, Irvine, CA 92612; (800) 366-6554; fax: (800) 752-7006.