Determining the Effect of Antibiotic Drop Prophylaxis on the Conjunctival Flora
Ranibizumab (Lucentis) is currently the best treatment for wet Age-Related Macular Degeneration (AMD). To work, the drug must be injected by means of an intravitreal injection (IVT) into the vitreous (jelly-like material) cavity in the back of the eye, repeatedly at intervals ranging from one to several months. Endophthalmitis is a rare but devastating infection of the eye that occurs in approximately 0.2% of patients after IVT injection. Many ophthalmologists ask patients to use antibiotic eye drops after IVT injection in the hope that this may reduce the risk of endophthalmitis. There is no proof that this happens and there is a possible risk that repeated exposure to the same antibiotic may cause antibiotic resistance organisms (bacteria) to develop over time.
The investigators hypothesize that repeated exposure to antibiotic during the initial stages of treatment for AMD will result in a progressive shift in the conjunctival flora with an increasing number of antibiotic resistant organisms appearing over time. If this is demonstrated, changes to the prevailing treatment approach will be needed to reduce the long term risk of a patient developing antibiotic resistant endophthalmitis during treatment.
Přehled studie
Postavení
Podmínky
Intervence / Léčba
Detailní popis
Intraocular injection of a VEGF inhibitor on a repeated basis has become the standard of care for the treatment of Age-Related Macular Degeneration (AMD) following pivotal studies which demonstrated that vision could be stabilized in 90% of treated patients. Most patients require injection, on average, every two months indefinitely.
The incidence of intraocular infection (endophthalmitis) following intraocular injection is approximately 0.2%. Current injection protocols involve the use of topical poviodine prior to injection based on evidence that this significantly reduces the bacterial flora on the conjunctiva. Following injection there is often some reflux of vitreous fluid from the cavity of the eye into the subjunctival space. For this reason many Ophthalmologists have patients use topical antibiotics for 2-3 days post injection with the expectation that this may reduce the risk of infection as the eye is healing.
Ta et al have demonstrated that following a 3 day course of topical antibiotic the incidence of resistant strains of bacteria in the conjunctival sac does not significantly increase (159 patients).There are no longitudinal studies which examine the effects of repeated short term antibiotic exposure on the conjunctival flora over time.
This is a prospective, randomized, comparative study which will follow the conjunctival flora of patients undergoing induction treatment with a VEGF inhibitor for AMD. The incidence of resistant organisms in the group receiving antibiotics will be compared to that in a similar group who do not receive antibiotics. Following informed consent, patients will have a conjunctival swab taken by the treating Ophthalmologist after instillation of sterile topical anesthetic but before application of poviodine. The swabs will be cultured in thyoglycollate broth. Bacteria present and resistance to the antibiotic used will be identified. This process will be repeated each visit during the induction phase of treatment which consists of four sequential injections each a month apart.
Patients in the antibiotic arm will be asked to use topical Moxifloxacin drops 4 times a day for 3 days following injection. The control group will not receive antibiotics.
Typ studie
Zápis (Aktuální)
Fáze
- Nelze použít
Kontakty a umístění
Studijní místa
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Ontario
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London, Ontario, Kanada, N6A 4V2
- Ivey Eye Institute, St. Joseph's Health Care Centre
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Kritéria účasti
Kritéria způsobilosti
Věk způsobilý ke studiu
Přijímá zdravé dobrovolníky
Pohlaví způsobilá ke studiu
Popis
Inclusion Criteria:
- all patients undergoing their first ever injection to treat AMD and who are expected to continue treatment in London for at least the next 3 injections are potentially eligible.
- able to provide Informed Consent.
Exclusion Criteria:
- current contact lens use.
- use of topical antibiotics in the study eye in the preceding 6 months.
- patients in whom eye surgery in the study eye is anticipated in the next 4 months.
- documented allergy to the drug or vehicle.
- patients with active ocular, periocular or systemic infection.
- immunosuppressed patients.
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Prevence
- Přidělení: Randomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Žádné (otevřený štítek)
Zbraně a zásahy
Skupina účastníků / Arm |
Intervence / Léčba |
|---|---|
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Aktivní komparátor: Moxifloxacin 0.5%
1 drop four times daily for 3 days in affected eye post intravitreal injection
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1 drop 4 times daily times 3 days post ranibizumab intravitreal injection
Ostatní jména:
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Žádný zásah: No antibiotic use
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Co je měření studie?
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
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Incidence of antibiotic resistant organisms
Časové okno: 4 months
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Conjunctival culture will be obtained in the designated "study" eye prior to the first intravitreal injection in de novo AMD patients and will be repeated prior to the next 3 injections. Susceptibility or resistance of the ocular surface flora to Moxifloxicin will be assessed by standard micro analysis. |
4 months
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Spolupracovníci a vyšetřovatelé
Sponzor
Spolupracovníci
Vyšetřovatelé
- Vrchní vyšetřovatel: Philip L Hooper, MD, FRCSC, Ivey Eye Institute, St. Joseph's Health Care Centre
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia
Primární dokončení (Aktuální)
Dokončení studie (Aktuální)
Termíny zápisu do studia
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Odhad)
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Odhad)
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Více informací
Termíny související s touto studií
Další relevantní podmínky MeSH
Další identifikační čísla studie
- R-10-458
- 17354 (Jiný identifikátor: REB)
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