A Clinical Comparison of Two Formulations of Tobramycin 0.3% Eyedrops in the Treatment of Acute Bacterial Conjunctivitis

Purpose

To compare the safety and efficacy of a new enhanced viscosity ophthalmic formulation of tobramycin, given twice daily (BID), with the existing four times daily (QID) treatment regimen in patients with acute bacterial conjunctivitis.

Methods

This was a 12-day, multicenter, observer-masked, randomized, parallel group study. Patients received one drop of tobramycin 0.3% (3 mg/mL) enhanced viscosity ophthalmic solution BID or tobramycin 0.3% (3 mg/mL) ophthalmic solution QID in the affected eyes for 7 days. The primary efficacy variable was the percentage of patients with sustained cure/presumed bacterial eradication based on clinical judgment at the test-of-cure visit (Day 12). Pretherapy bacterial isolates were obtained and tested for susceptibility to tobramycin by determination of minimum inhibitory concentrations (MIC).

Results

A total of 276 patients were enrolled in the study and 203 of these were culture positive and attended all follow-up examinations. In this group, 98% of those treated with tobramycin enhanced viscosity ophthalmic solution and 99% of those treated with tobramycin 0.3% ophthalmic solution were categorized as having sustained cure/presumed eradication at the test-of-cure visit (p=0.6037). Reported adverse events were not serious, mild to moderate in severity, and generally did not prevent continuation in the study. Several pretreatment pathogens demonstrated tobramycin resistance (MIC > 4 mg/mL). However, therapy with both treatments was effective in the majority of the cases.

Conclusions

Tobramycin enhanced viscosity ophthalmic solution is well tolerated and has equivalent efficacy to the established treatment regimen with a simplified posology. The formulation provides an alternative therapy for acute bacterial conjunctivitis that should improve patient compliance and satisfaction.

Skin involvement in leukemia

Skin infiltration in leukaemia occurs rarely. We describe here four such cases of acute leukaemia. In two, the skin infiltration was evident at presentation; in the other two, it developed while on treatment. The lesions varied from maculopapular to tumorous stage. Complete remission could be achieved with chemotherapy, however, the long term prognosis was poor.

Vincristine infusion in advanced non Hodgkin's lymphoma

Prognosis in cases of advanced Non Hodgkin's Lymphoma refractory to primary chemotherapy - continues to be poor. In search of suitable alternative we have recently treated six such patients with continuous, intravenous infusion of vincristine for five days. All patients had a variety of histological types and had received earlier primary combination chemotherapy including Vincristine by Intravenous bolus injection. A total of 21 courses (average 3.5) were given. Three patients (50%) achieved objective-partial response. Duration of response varied from two to nine months (mean 4.5 months). Toxicity was low with minimal myelosuppression and no increased neurotoxicity occurred. Vincristine infusion treatment may provide better palliation in advanced refractory Non Hodgkin's lymphoma and suggests the possibility of its use in combination chemotherapy protocols in untreated patients.

Low-dose cytosine arabinoside in acute non-lymphoblastic leukemia

Eighteen previously untreated patients with acute non-lymphoblastic leukemia (ANLL) were treated with cytosine arabinoside (Ara-C) in low doses (10 mg/m2 every 12 hours) subcutaneously for 3 weeks. Complete remission (CR) was achieved in four patients (22.2%), and myelosuppression was observed in nearly all of them. Thrombocytopenia (20 X 10(3)/microliters) was pronounced in the third week of treatment and six patients (33.3%) needed platelet support. Contrary to earlier claims, our experience suggests that treatment with low-dose Ara-C is associated with significant cytopenias. Ara-C does not obviate the need for intensive supportive care and CR rates are no longer better. Low-dose Ara-C does not seem to be a choice in previously untreated ANLL patients who otherwise have a high probability of achieving a CR with standard multidrug chemotherapy protocols.

Fetal liver infusion in acute myelogenous leukaemia

Forty-five patients with acute myelogenous leukaemia (AML) received induction chemotherapy with either a conventional dose of cytarabine and daunorubicin (27 patients) or a low dose of cytarabine (18 patients). Maintenance chemotherapy was given to all responders. In 14 of 39 evaluable patients, infusion of fetal liver cells from 10-24 weeks old foetuses was given following induction as well as maintenance therapy. Six of 14 patients (43%) achieved a complete remission; 2 showed evidence of transient engraftment documented by analysis of sex chromosomes and RBC antigens (1 patient each). Fetal liver infusion within 6 days of completing induction chemotherapy appeared more effective than when given later. Five of 25 patients (20%) who did not receive fetal liver infusion achieved a complete remission. The present work suggests that fetal liver infusion given following induction chemotherapy may increase the remission rate in AML either by temporary engraftment or by accelerating the rate of haematological recovery.

Fetal liver infusion in aplastic anaemia

Forty patients with severe aplastic anaemia received an intravenous infusion of 0.004 to 11.1 x 10(8) (median: 8 x 10(8) hematopoietic cells prepared from the fetal livers of 8-32 week old abortuses. Five patients, who died within 15 days of fetal liver infusion, are excluded from analysis. Twenty-two of the 35 evaluable patients (62%) responded favourably. Six of the 7 patients with good response were alive after 9 to 44 months (median: m = 20); one died 106 months after fetal liver infusion due to renal lithiasis. Four of the 7 with moderate response were alive after 9 to 31 months; 3 died within 16 months. Of 8 patients with minimal response, one was lost to follow-up and the others died in 3.4 to 10 months (m = 6). Median survival of responders was 15.7 months. Bone marrow cellularity became normal in 12 patients following fetal liver infusion. In seven patients, there was a relapse; 6 regained a normal bone marrow cellularity after a second or third fetal liver infusion. These data strongly suggest a role of fetal liver infusion in inducing bone marrow recovery. Of 13 non-responders, 4 were lost to follow-up and 9 died within 20 days-4.3 months (m = 1.6). Fetal liver infusion appears to be an effective therapy in patients with severe aplastic anaemia.