토수플록사신 0.3% 점안약의 안구표면상재균에 대한 균음성률과 전방내 농도에 관한 연구결과
Clinical Analysis of the 0.3% Tosufloxacin Ophthalmic Solution Effect on Conjunctival Normal Flora
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목적: 안구내 미세수술 전 예방적 목적의 토수플록사신 0.3% 점안약의 안구 표면 상재균에 대한 균음성율과 전방내 잔류 농도에 대한임상적 연구 결과를 보고하고자 한다. 대상과 방법: 백내장 수술 혹은 황반부 질환으로 유리체강 내 주사가 예정된 38안을 대상으로 수술 2일 전 결막 찰과 표본으로부터세균 배양 검사를 시행한 후 2일 동안 토수플록사신 0.3% 점안액을 1일 5회 점안하고 2차로 검사를 시행하여 균음성률을 검사하였다. 백내장 수술이 예정된 19명 19안에 대해서 수술 전 2일간 토수플록사신을 1일 5회씩 점안하고 수술당일 1시간 전에 15분 간격으로 4번점안한 후 수술시작시점에 전방수를 채취하여 토수플록사신의 전방 내 잔류 농도를 측정하고, 약제에 의한 부작용 등을 조사하였다. 결과: 38안 중 결막낭 균주 양성인 21명의 환자에서 2일간 약제 점안 후 이 균들에 대해 균음성률은 57.1%을 보였다. 응고효소 음성포도알균이 항생제 점안 전에 15안에서 배양되어 39%로 가장 많은 환자에서 배양되었으며 이 균주에 대해 86.7% (13/15)의 균음성률을 보였다. 그리고 전방 내 잔류 농도는 0.050 ± 0.038 (μg/mL)이었고 시험 기간 내 약물 사용의 부작용은 관찰되지 않았다. 결론: 안구 내 수술 전 토수플록사신 항생제는 상대적으로 전방내 유입이 적고 안구표면의 모든 항균재에 효과적이지는 않다는 제한점이 있지만, 응고효소 음성 포도알균에 대하여 항균력이 있고 이 균에 의한 안염증 발생의 억제에 효과적으로 생각한다.
Abstract
Purpose: To report the outcomes of clinical analysis on the negative culture rate of normal ocular surface flora and the anteriorchamber penetration after the preoperative prophylactic use of 0.3% tosufloxacin ophthalmic solution. Methods: From July 2010 to June 2012, 38 eyes of 38 patients who were scheduled to receive intravitreal injection or cataractsurgery were examined for bacterial culture positive rate using conjunctival scraping. The patients were treated with 0.3% tosufloxacineyedrops preoperatively 5 times a day for 2 days before surgery. After the treatment, the bacterial culture negative ratebased on conjunctival scraping was assessed to evaluate the drug efficacy. Of the 38 patients, 19 had cataract surgery. The concentrationof tosufloxacin at anterior chamber was assessed in the 19 patients. Additionally, any side effects from the drug weremonitored during the treatment. Results: Among the 38 eyes, 21 eyes showed a bacterial culture positive rate before treatment. After the drug treatment, the bacterialculture negative rate was 57.1% (12/21). Coagulase-negative staphylococci were most frequently cultured in 15 (39%) ofthe 38 eyes before treatment and the negative rate of bacterial culture was 86.7% (13/15) after treatment. Average antibiotic residueconcentrations in aqueous humor was 0.050 ± 0.038 μg/mL. No side effects from the drug were reported during the experimentalperiod. Conclusions: Although the 0.3% tosufloxacin eyedrops were not effective in all bacterial strains and showed relatively low penetrationrate into the anterior chamber, they were effective in some gram positive organisms, particularly in coagulase-negativestaphylococci of normal ocular surface flora.
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