Pharmacological Management of Bacterial Keratitis: Comparative Effectiveness of Topical Antibiotics and Antimicrobial Resistance Patterns - A Systematic Review and Meta-analysis
Abstract
Background: Bacterial keratitis is a sight-threatening corneal infection requiring immediate topical antimicrobial treatment.Fluoroquinolone monotherapy offers broad coverage, commercial availability, and convenient preparation, whereas fortified combinations such as cefazolin plus tobramycin provide high concentrations and broader Gram-positive and Gram-negative coverage.Increasing antimicrobial resistance may reduce the reliability of empirical fluoroquinolone treatment and contribute to delayed healing, treatment modification, corneal perforation, and surgical intervention.Objective: To compare the clinical effectiveness and safety of commonly used topical antibiotic regimens for bacterial keratitis and to estimate pooled antimicrobial-resistance patterns among bacterial corneal isolates.Methods: A systematic review and meta-analysis was structured according to PRISMA 2020 principles.MEDLINE/PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL were considered, together with citation and reference-list searching.Randomized and comparative studies evaluating topical fluoroquinolone monotherapy, fortified antibiotic combinations, or alternative topical antibacterial regimens were eligible for the effectiveness analysis.Microbiological surveillance studies reporting susceptibility results from bacterial corneal isolates were eligible for the resistance analysis.Random-effects models were used to estimate risk ratios, mean differences, and pooled resistance…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,086 participants or records.
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