Background: Fungal keratitis is common in agricultural tropical countries but relatively uncommon in developed countries. Although there are medications available, their effectiveness is unclear.
Objectives: The purpose of the review was to examine the effect of different antifungal drugs in the management of fungal keratitis.
Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) in The Cochrane Library (Issue 4, 2006), MEDLINE (1966 to January 2007), EMBASE (1980 to January 2007), LILACS (Latin American and Caribbean Literature on Health Sciences), reference lists of primary reports, review articles and conference proceedings. We contacted investigators and experts in the field for details of published and unpublished reports.
Selection criteria: We included all relevant randomised controlled trials on medical therapy for fungal keratitis.
Data collection and analysis: Two review authors extracted and assessed trial quality. Interventions were compared by the proportions of participants that did not heal after a specific time of therapy. No meta-analysis was performed because the trials studied different medications with different concentrations.
Main results: Six trials were identified which compared different antifungal drugs namely: 1% topical itraconazole versus 1% topical itraconazole and oral itraconazole, different concentrations of silver sulphadiazine versus 1% miconazole, 1% silver sulphadiazine ointment versus 1% miconazole ointment, 2% econazole versus 5% natamycin, different concentrations of topical chlorhexidine gluconate versus 5% natamycin, and 0.2% chlorhexidine gluconate versus 2.5% natamycin. A total of 370 participants were randomised. No single reference drug was used. All trials considered clinical cure as primary outcome. Comparing treatment effects of all the drug preparations studied, silver sulphadiazine ointment had the lowest proportion of participants with treatment failure followed by itraconazole, miconazole, chlorhexidine, econazole, and the drug with the most treatment failure was natamycin. These differences were not, however, statistically significant which might in part be due to low sample sizes.
Authors' conclusions: There is no evidence that the current available and investigational antifungal agents are effective. The review identified the need for large multicentre randomised trials.