Copyright 2006 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
In reply
We appreciate the comments from Drs Fiscella and Jensen. The dual-biopsy technique is an optimal method for assessing conjunctival anti-infective concentrations. And, we strongly agree that additional factors should also be considered when evaluating drug efficacy.
Conjunctival drug levels are of particular importance in bacterial conjunctivitis because the conjunctiva is the tissue to which the bacteria adhere—the site of infection. This, of course, is not a difficult concept. We disagree that the formulation concentration differences between 0.5% moxifloxacin and 0.3% gatifloxacin resulted in the difference in conjunctival concentration. In fact, 0.5% levofloxacin had a lower mean conjunctival concentration (2.34 μg/g) than 0.3% gatifloxacin (2.54 μg/g).
The dual-biopsy technique is an excellent method for measuring anti-infective drug concentrations and could also be adapted for any other ophthalmic medication. To obtain an adequate quantity of tissue for analysis, previous methods for assessing conjunctival antibiotic concentrations described 1 large biopsy specimen taken during cataract surgery.1 Our method uses 2 smaller tissue samples that can be taken in the office in a normal patient population. This allows for rapid healing and less chance of infection.
We agree that gatifloxacin may be a choice superior to ciprofloxacin in treating ocular infection. The same can be said of moxifloxacin, a fourth-generation fluoroquinolone like gatifloxacin that also offers lower minimum inhibitory concentrations and may be less susceptible to resistance compared with previous fluoroquinolone generations.2
There is no clinical evidence of any safety issues with any of the fluoroquinolones studied. The moxifloxacin Food and Drug Administration labeling states that ocular adverse events were reported in approximately 1% to 6% of subjects while the gatifloxacin Food and Drug Administration labeling states that some ocular adverse events were seen at a rate of 5% to 10%. We are very fortunate to have exceptional safety profiles for all of the leading ophthalmic antibiotics. We agree that gatifloxacin, which is indicated to be dosed at a higher frequency than moxifloxacin (every 2 hours for up to 8 times daily on days 1 and 2), is an entirely safe and effective medication.
The referenced studies do not meet the standards of well-controlled clinical trials. Certainly, the “open-label, partially randomized” study performed by Moshirfar et al3 requires no further comment. It is also important to note that 2 separate groups4 - 5 were unable to reproduce the results found by Solomon et al.6 In addition, Donnenfeld et al7 reported major end points graded using scales that were “not validated or standardized.” In any case, this is not the forum for discussing corneal wound healing studies when the subject at hand is bacterial conjunctivitis.
Last, it should be noted that following the biopsy procedure, all of the subjects were provided with moxifloxacin to be used prophylactically for 1 week. Subjects were seen at 1 day and 1 week after the biopsy to monitor healing, and no subjects in our study evidenced a delay in wound healing.
Correspondence: Dr Wagner, Doctors Office Center, Suite 6100, PO Box 1709, Newark, NJ 07101-1709 (wagdoc@comcast.net).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Archives of Ophthalmology editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.