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Povidone-iodine promising for bacterial keratitis in developing world
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Povidone-iodine 1.25% can be considered for the treatment of bacterial keratitis when antibiotic treatment is not practical, according to researchers in the American Journal of Ophthalmology.
The randomized, controlled, investigator-masked clinical trial compared povidone-iodine 1.25% ophthalmic solution with topical antibiotics for bacterial keratitis in areas of the world where use of effective topical antibiotics may not be an option.
A total of 172 adults with bacterial keratitis were randomized to be treated with either povidone-iodine (40 patients in the Philippines, 38 in India) or the control antibiotic (49 patients in the Philippines, 45 in India).
Researchers assessed the intervals from beginning of treatment to “presumed cure, defined as closed epithelial defect without associated inflammatory signs, to the “recovering” stage, where residual epithelial defect was less than 1 mm2 with only minimal inflammation.
Thirty patients out of 40 treated with povidone-iodine and 39 out of 49 treated with neomycin-polymyxin B-gramicidin in the Philippines achieved cure.
In India, 12 individuals out of 38 treated with povidone-iodine and 10 individuals from 45 treated with ciprofloxacin achieved cure.
The median interval to presumed cure was 7 days for povidone-iodine and 7 days for neomycin-polymyxin-B-gramicidin in the Philippines and 12 days for povidone-iodine and 17 days for ciprofloxacin in India
In patients treated with povidone-iodine vs. antibiotics, the hazard ratio (HR) for presumed cure was 1.46 in the Philippines and 1.70 in India, according to researchers.
The researchers determined no significant difference by comparing the intervals to recovering and HR for recovering nor a difference between treatment groups in either country.
“Although overall trends appeared to favor treatment with povidone-iodine, our goal was not to show superiority of povidone-iodine over antibiotics,” researchers wrote.
They suggest that the results are applicable to children as well, “who are disproportionately affected by infectious keratitis in the developing world,” they wrote.
“Our conclusions regarding the utility of povidone-iodine are supported by the fact that we obtained similar results in two different countries, with different spectrums of causal bacteria, and that results were consistent across different types of comparisons, using multiple outcome measures,” they concluded. – by Abigail Sutton
Disclosure: Isenberg reported no relevant financial disclosures. Please see the full study for all other authors’ financial disclosures.
Perspective
Back to TopAndrew S. Gurwood , OD
The paper explained that povidone-iodine 1.25% ophthalmic solution may compare favorably with topical antibiotics for treating bacterial keratitis in areas of the world where locating effective topical antibiotics may not be an option.
In two separate studies done in two different countries, success with povidone-iodine was achieved by either matching or surpassing therapy achieved with a control topical antibiotic.
The study sample size was small and the results helpful, but not robust. The study supports what we have always known about this compound.
Topical povidone-iodine solution seems to be an inexpensive, steadily available compound with a solid pedigree for performance as both an ocular antiseptic and ocular antimicrobial. The current standard of care for bacterial keratitis calls for topical antibiotics (fluoroquinolone preparations preferred) if they are available. However, in the instance they (topical antibiotics) are not, there is reasonable data in the literature supporting use of this off-label alternative instead of using nothing at all.
While povidone-iodine performed reasonably well in comparison to the prescribed antibiotic regimen, neither regimen would be considered first-line therapy in developed nations. To reach for topical povidone-iodine ocular solution as a drug-of-first-choice for bacterial keratitis over a properly selected topical antibiotic based on this publication would be both premature and not advised.
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