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кератиты. Only you...

Запись от opto_dive размещена 09.01.2009 в 22:04
Bacterial KeratitisTopical corticosteroids have an unclear role in the management of bacterial keratitis. The typical objective is to reduce an exaggerated inflammatory response and minimize corneal scarring, while not impairing the healing response. One systematic review (see Table 3.14) found that prior usage of corticosteroids increased the risk of antibiotic treatment failure or other infectious complications.171 From this review, two recommendations reached most important levels. First, topical corticosteroids should be avoided if the causative agent is unknown and, second, topical corticosteroids should be utilized when, after using clinical or laboratory criteria, it is deemed important to aid reepithelialization or minimize stromal alteration and scarring. In practice, before administering topical corticosteroids, the American Academy of Ophthalmology Preferred Practice Pattern on this subject suggests waiting 2 to 3 days after topical antibiotic therapy has been initiated and in which progress is being made in treating the infection.172 If topical corticosteroids are initiated, it is important to follow up the patient closely in the initial period to insure against recrudescence of the infectious process.
TABLE 3.14 Corticosteroids for Bacterial Keratitis
Study question Determine the effects of topical corticosteroids with bacterial keratitis.
Study design Systematic review
Inclusion/exclusion criteria Bacterial keratitis was defined as a stromal infiltrate with an overlying epithelial defect that warranted intensive antibacterial therapy. All topical corticosteroids studied were considered equivalent.
Intervention Sources included electronic searching of MEDLINE and EMBASE through 2000; used the text words keratitis or corneal ulcer combined with corticosteroid, cortisone, dexamethasone, or prednisolone, without language restrictions. Other sources were identified by manually searching Index Medicus from 1960 through 1965, Excerpta Medica Ophthalmology from 1960 to 1973, and Ophthalmic Literature from 1950 to 1999. Reference lists of primary reports, review articles, and corneal textbooks were searched for additional relevant articles dating from 1950.
Primary outcome measures Positive and negative effects of corticosteroids used before and during therapy for bacterial keratitis
Major findings Avoid topical corticosteroids if the causative microorganism is unknown.
Add a topical corticosteroid if the organism is known and treatment, by clinical, or laboratory criteria, is necessary to aid reepithelialization and/or minimize stromal alteration.
Unanswered questions If topical corticosteroids have value:
- Who is a good candidate for therapy?
- When should topical corticosteroids be initiated?
- At what frequency and dosage should they be initiated?
- How long should they be continued?

Взято из Evidence-Based Eye Care, 1st Edition Editors: Kertes, Peter J.; Johnson, T. Mark Copyright В©2007 Lippincott Williams & Wilkins
Удивительно: стероиды при эндофтальмитах в двух РКИ - в Европе: помогают, в Америке почему-то нет, кто ж плохо провел РКИ?

Только помнить нужно, что стероиды повышают летальность при ЧМТ...
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