Natamycin in the treatment of fungal keratitis:a systematic review and Meta-analysis

• Main Authors: Sheng Qiu, Gui-Qiu Zhao, Jing Lin, Xue Wang, Li-Ting Hu, Zhao-Dong Du, Qian Wang, Cheng-Cheng Zhu
• Format: Article
• Language: English
• Published: Press of International Journal of Ophthalmology (IJO PRESS) 2015-06-01
• Series: International Journal of Ophthalmology
• Subjects: eye infection; fungal; natamycin; Meta-analysis
• Online Access: http://www.ijo.cn/en_publish/2015/3/20150329.pdf
• ISSN: 2222-3959; 2227-4898

<b>AIM:</b> To review published clinical studies examining the effect of natamycin in the treatment of fungal keratitis.<b>METHODS:</b>We selected the publications in CENTRAL, MEDLINE, EMBASE, CNKI, and CBM. This study systematically reviewed published randomized controlled trials (RCTs) that compared natamycin to other antifungal agents, and conducted feasible Meta-analysis of efficacy results using Revman 5.2 software.<b>RESULTS:</b> We included seven trials which were mainly carried out in developing countries of Asia, with five trials conducted in India, one each in China and Bangladesh. A total of 804 participants were randomized to following comparisons:2% econazole versus 5% natamycin showed little difference in the effects of treatment of fungal keratitis [RR=0.99, 95% confidence interval (CI), 0.8 to 1.21]; chlorhexidine gluconate versus 5% natamycin indicated that the results on healing of the ulcer at 21d was less conclusive (RR=0.77, 95% CI, 0.55 to 1.08; <i>I</i>²=0%); 1% voriconazole versus 5% natamycin suggested that natamycin treatment appeared to be significantly better outcomes than voriconazole (regression coefficient =-0.18 logMAR; 95% CI, -0.30 to -0.05; <i>P</i>=0.006), especially in <i>Fusarium</i> cases (regression coefficient=-0.41 logMAR; 95% CI, -0.61 to -0.20; <i>P</i>&lt;0.001); natamycin versus fluconazole showed a significant difference in cure rate (χ² =5.048, <i>P</i>&lt;0.05) and natamycin group was more effective than fluconazole in average period of therapy (<i>t</i>=7.94, <i>P</i>&lt;0.01).<b>CONCLUSION:</b> Natamycin was a preferable choice in the treatment of fungal keratitis, especially in the early period of<i> Fusarium</i> cases.