A Prospective, Randomized Trial of Povidone-Iodine 0.6% and Dexamethasone 0.1% Ophthalmic Suspension for Acute Bacterial Conjunctivitis

Am J Ophthalmol. 2020 Jul:215:56-65. doi: 10.1016/j.ajo.2020.03.018. Epub 2020 Mar 25.

Abstract

Purpose: To evaluate the efficacy and safety of a topical ophthalmic suspension combination of povidone-iodine 0.6% (PVP-I) and dexamethasone 0.1% (DEX) for infectious and inflammatory components of bacterial conjunctivitis.

Design: Randomized, double-masked, multicenter, phase 3 clinical trial.

Methods: Subjects of all ages (those <3 months had to be full-term) with a diagnosis of bacterial conjunctivitis were randomized 3:1:3 to either PVP-I/DEX, PVP-I alone, or placebo. The primary endpoint was clinical resolution in the study eye, and the key secondary efficacy endpoint was bacterial eradication, both at the day 5 visit. Adverse events (AEs) were documented at all visits.

Results: Overall, 753 subjects were randomized (intent-to-treat [ITT] population; PVP-I/DEX [n = 324]; PVP-I [n = 108]; placebo [n = 321]); mean and standard deviation (SD) age was 44.3 (22.9) years, and most were female (61.2%) and white (78.1%). In all treatment groups, mean treatment compliance was >98%. The modified ITT population for the efficacy analysis comprised 526 subjects. In the study eye at the day 5 visit, clinical resolution was achieved by 50.5% (111/220) subjects in the PVP-I/DEX group vs 42.8% (95/222) in the placebo group (P = .127), and bacterial eradication was achieved by 43.3% (94/217) and 46.8% (102/218), respectively (P = .500). Treatment-emergent AEs were experienced by 32.8% (106/323), 39.8% (43/108), and 19.0% (61/321) of subjects in the safety population treated with PVP-I/DEX, PVP-I, and placebo, respectively (most mild in severity).

Conclusion: In this study, PVP-I/DEX did not demonstrate additional benefit in clinical efficacy compared with placebo in subjects with bacterial conjunctivitis.

Publication types

  • Clinical Trial, Phase III
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Administration, Ophthalmic
  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Infective Agents, Local / therapeutic use*
  • Bacteria / isolation & purification
  • Conjunctivitis, Bacterial / drug therapy*
  • Conjunctivitis, Bacterial / microbiology
  • Conjunctivitis, Bacterial / physiopathology
  • Dexamethasone / therapeutic use*
  • Double-Blind Method
  • Drug Therapy, Combination
  • Eye Infections, Bacterial / drug therapy*
  • Eye Infections, Bacterial / microbiology
  • Eye Infections, Bacterial / physiopathology
  • Female
  • Glucocorticoids / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Ophthalmic Solutions
  • Povidone-Iodine / therapeutic use*
  • Prospective Studies
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Anti-Infective Agents, Local
  • Glucocorticoids
  • Ophthalmic Solutions
  • Dexamethasone
  • Povidone-Iodine