Background
Methods
Results
Quantitative analysis
Pharmaco-therapeutic Group | Drug name | Licence Status | RCTs | |||
---|---|---|---|---|---|---|
IT | UK | USA | Published | Non-published | ||
ANTI-ALLERGY MEDICATIONS
|
14/12*
|
8/8*
|
11/10*
|
34
|
5
| |
Anti-histamine agent
| Azelastine | ≥ 4 yrs | ≥ 12 yrs | ≥ 3 yrs | 4 | - |
Emedastine | ≥ 3 yrs | ≥ 3 yrs | ≥ 3 yrs | 1 | - | |
Epinastine | ≥ 12 yrs | ≥ 12 yrs | ≥ 3 yrs | - | - | |
Ketotifen | ≥ 3 yrs | ≥ 3 yrs | ≥ 3 yrs | 5 | 3 | |
Levocabastine | all | NA** | NA | 6 | - | |
Olopatadine | ≥ 3 yrs | ≥ 3 yrs | ≥ 3 yrs | 4 | 1 | |
Mast cell stabilizer
| Spaglumic acid | all | NA | NA | - | - |
Lodoxamide | all | ≥ 4 yrs | > 2 yrs | 1 | - | |
Nedocromil sodium | ≥ 6 yrs | ≥ 6 yrs | ≥ 3 yrs | 5 | - | |
Sodium cromogligate | ns** | all | NA | 6 | - | |
Pemirolast | NA | NA | ≥ 3 yrs | - | - | |
Decongestant (Sympathomimetic agent)
| Naphazoline | ≥ 10 yrs | NA | nl | - | 1 |
Oxymetazoline | ≥ 3 yrs | NA | ≥ 6 yrs | - | - | |
Tetryzoline | ≥ 3 yrs | NA | ≥ 6 yrs | - | - | |
ANTI-ALLERGY COMBINATIONS
|
3/3
|
1/1
|
2/2
|
0
|
0
| |
Anti-histamine agent + Decongestant
| Antazoline + Xylometazoline | NA | ≥ 5 yrs | NA | - | - |
Chlorpheniramine + Tetryzoline | ≥ 3 yrs | NA | NA | - | - | |
Pheniramine + Tetryzoline | ≥ 3 yrs | NA | NA | - | - | |
Mast cell stabilizer + Decongestant
| Cromoglicate + Tetryzoline | ≥ 3 yrs | NA | NA | - | - |
Astringent + Decogestant
| Zinc sulfate + Tetryzoline | NA | NA | ≥ 6 yrs | - | - |
Decogestant + Lubricants
| Tetryzoline + Povidone + Dextran 70 + Polyethylene glycol 400 | NA | NA | ≥ 6 yrs | - | - |
ANTI-GLAUCOMA MEDICATIONS
|
23/6
|
14/1
|
6/1
|
4
|
3
| |
Beta-blocker
| Timolol | > 1 m | nl** | nl | 4 | 2 |
Carbonic anhydrase inhibitor
| Dorzolamide | all | nl | ns | - | |
Sympathomimetic agent (selective α
2
- agonist)
| Apraclonidine | ≥ 12 yrs | ≥ 12 yrs | nl | - | - |
Brimonidine | ≥ 12 yrs | NA | ≥ 2 yrs | - | 1 | |
Clonidine | ns | NA | NA | - | - | |
Parasympathomimetic (colinergic) agent
| Aceclidine | ≥ 3 yrs | NA | NA | - | - |
Pilocarpine | ≥ 3 yrs | nl | Nl | - | - | |
ANTI-GLAUCOMA COMBINATIONS
|
2/1
|
1/0
|
2/2
|
1
|
0
| |
Beta-blocker + Carbonic anhydrase inhibitor
| Timolol + Dorzolamide | ≥ 2 yrs | nl | ≥ 2 yrs | 1 | - |
Beta-blocker + Sympathomimetic agent
| Timolol + Brimonidine | nl | NA | ≥ 2 yrs | - | - |
ANTI-INFLAMMATORY MEDICATIONS
|
16/8
|
8/5
|
5/2
|
16
|
6
| |
Non-Steroidal Anti-Inflammatory Drug (NSAID)
| Diclofenac | ≥ 3 yrs | nl | nl | 4 | 1 |
Indomethacin | ≥ 3 yrs | NA | NA | - | - | |
Ketorolac | NA | nl | ≥ 3 yrs | 3 | - | |
Steroid agent
| Betamethasone | NA | all | NA | - | - |
Desonide | > 1 m | NA | NA | - | - | |
Dexamethasone | > 1 m | all | nl | 6 | 2 | |
Fluorometholone | ≥ 2 yrs | ≥ 2 yrs | ≥ 2 yrs | 3 | 1 | |
Hydrocortisone | > 1 m | all | NA | - | - | |
Prednisolone
| NA | all | nl | - | 2 | |
Clobetasone | >1 m | NA | NA | - | - | |
Steroid agent + Decongestant
| Fluorometholone + Tetryzoline | ≥ 2 yrs | NA | NA | - | - |
Clobetasone + Tetryzoline | ns | NA | NA | - | - | |
ANTI-INFECTIVE MEDICATIONS
|
21/13
|
9/9
|
10/7
|
27
|
3
| |
Antibacterial agent
| Chloramphenicol | ≥ 3 yrs | all | NA | 7 | - |
Fusidic acid | ns | all | NA | 3 | - | |
Propamidine isetionate | NA | all | NA | - | - | |
Aminoglycoside
|
Gentamycin
| ≥ 3 yrs | all | >1yr | 2 | 1 |
Neomycin | NA | all | NA | - | - | |
Netilmycin | > 1 m | NA | NA | - | - | |
Tobramycin | ≥ 1 yr | NA | nl | 3 | - | |
Quinolone
| Ciprofloxacin | all | ≥ 1 yr | ≥ 1 yr | 2 | - |
Gatifloxacin | NA | NA | ≥ 1 yr | - | ||
Levofloxacin | ≥ 1 yr | ≥ 1 yr | ≥ 1 yr | 2 | - | |
Lomefloxacine | ≥ 1 yr | NA | NA | - | - | |
Moxifloxacin | ≥ 1 m | nl | ≥ 1 yr | 3 | ||
Ofloxacin | nl ophtalmia neonatorum | > 1m | ≥ 1 yr | 1 | - | |
Antiviral agent
|
Acyclovir
| all | all | nl | - | - |
Idoxuridine | ≥ 3 yrs | NA | NA | - | - | |
Trifluridine | all | NA | ≥ 6 yrs | - | - | |
Other anti-infective agent
| Povidone - Iodine | > 1 m | NA | nl | 4 | 2 |
ANTIBACTERIAL COMBINATIONS
|
9/2
|
6/3
|
4/1
|
3
|
0
| |
Antibacterials
| Polimyxin B + Trimethoprim | NA | all | > 2 ms | 1 | - |
Polimyxin B + Bacitracin | NA | all | nl | 1 | - | |
Neomycin + Polymyxin B + Gramicidin | NA | ≥ 2 yrs | nl | - | - | |
Neomycin + Chloramphenicol | ns | NA | NA | - | - | |
Antibacterial + Steroid
| Neomycin + Polymyxin B + Dexamethasone | nl | all | ≥ 2 yrs | - | - |
Neomycin + Polymyxin B + Hydrocortisone | NA | NA | ns | - | - | |
Neomycin + Chloramphenicol + Hydrocortisone | ns | NA | NA | - | - | |
Neomycin + Prednisolone | ns | all | NA | - | - | |
Neomycin + Fluocinolone | ns | NA | NA | - | - | |
Neomycin + Betamethasone | NA | all | NA | 1 | - | |
Tobramycin + Dexamethasone | nl | NA | ≥ 2 yrs | - | - | |
Prednisolone + Sulphacetamide | NA | NA | ≥ 6 yrs | - | - | |
Tobramycin + Fluorometholone | NA | NA | ≥ 2 yrs | - | - | |
Antibacterial + Steroid + Decongestant
| Neomycin + Gramicidin + Tetryzoline + Dexamethasone | ≥ 3 yrs | NA | NA | - | - |
Betamethasone + Sulphacetamide + Tetryzoline | ≥ 2 yrs | NA | NA | - | - | |
MYDRIATIC/CYCLOPLEGIC MEDICATIONS
|
7/4
|
6/5
|
2/1
|
55
|
3
| |
Antimuscarinic agent
| Cyclopentolate | ≥ 3 yrs | > 3 ms | all | 14 | - |
Homatropine | ns | > 3 ms | nl | - | - | |
Tropicamide | > 1 m | all | NA | 10 | - | |
Atropine
| ns | > 3 ms (nl uveitis) | NA | 31 | 3 | |
Ibopamine | all | NA | NA | - | - | |
Decongestant (Sympathomimetic agent)
| Phenylephrine | ≥ 12 yrs | All (nl 10% drops) | NA | 2 | - |
PERI-OPERATIVE MEDICATIONS
|
2/0
|
4/4
|
1/0
|
4
|
0
| |
Local anaesthetic
| Lidocaine | nl | all | nl | 2 | - |
Oxybuprocaine | ns | all | NA | 1 | - | |
Proxymetacaine | NA | all | NA | - | - | |
Tetracaine
| NA | all | NA | 1 | - | |
LUBRICANTS AND ASTRIGENTS
|
5/0
|
10/5
|
4/0
|
0
|
0
| |
Ocular lubricant and astringent
| Polyvinyl alcohol | Ns | all | NA | - | - |
Carmellose sodium | ns | all | NA | - | - | |
Hydroxyethylcellulose | NA | all | NA | - | - | |
Paraffin | NA | all | NA | - | - | |
Sodium hyaluronate | ns | all | NA | - | - | |
Hypromellose | NA | all | nl | - | - | |
LUBRICANT COMBINATIONS
|
0/0
|
2/2
|
6/2
|
0
|
0
| |
Lubricants
| Hypromellose + Glycerin | NA | NA | all | - | - |
Hypromellose + Dextran 70 | NA | all | nl | - | - | |
Hypromellose + Glycerin + Polyethylene glycol 400 | NA | NA | ≥ 6 yrs | - | - | |
Lubricant + Steroid agent
| Hypromellose + Dexamethasone | NA | all | NA | - | - |
OTHER OCULAR MEDICATIONS
|
2/1
|
2/2
|
2/1
|
0
|
0
| |
Hypertonic agent
| Sodium chloride | NA | all | Nl | - | - |
Ocular diagnostic agent
| Fluorescein | ns | all | NA | - | - |
Topical immunomodulator
| Cyclosporine 0.05% | NA | NA | ≥ 16 yrs | - | - |
Other ocular agent
| Heparin | > 1 m | NA | NA | - | - |
TOTAL SINGLE DRUGS
|
68
|
88/43
|
61/39
|
41/22
|
140
|
20
|
TOTAL COMBINATIONS
|
29
|
16/7
|
10/6
|
14/7
|
4
| - |
Qualitative analysis
Bibliographic search
Pharmaco-therapeutic Group | Drug name | Formulation | N° RCTs | N° Children | Age range |
---|---|---|---|---|---|
MYDRIATIC/CYCLOPLEGIC MEDICATIONS | 74 (35%) | ||||
Antimuscarinic agent
| Atropine | eye drops 1% | 31 | 3530 | all |
Cyclopentolate | eye drops 0.5% | 2 | 28 | ≤ 13 yrs | |
eye drops 1% | 11 | 181 | ≤ 16 yrs | ||
Tropicamide | eye drops 1% | 9 | 348 | all | |
Pirenzepine | ophthalmic gel 1% | 3 | 276 | 6 - 12 yrs | |
Cyclopentolate/Tropicamide | eye drops 1%/1% | 6 | 176 | all | |
Sympathomimetic agent
| Phenylephrine | eye drops 2.5% | 1 | 10 | ≤ 1 m |
Antimuscarinic agent + Sympathomimetic agent
| Tropicamide/Phenylephrine | eye drops 1%/2.5% | 3 | 92 | ≤ 1 m |
eye drops 0.5%/2.5% | 2 | 51 | ≤ 8 yrs | ||
eye drops 0.5%/0.5% | 1 | 12 | 3-11 yrs | ||
Cyclopentolate/Phenylephrine | eye drops 1%/2.5% | 2 | 30 | ≤ 6 yrs | |
eye drops 0.2%/1% | 3 | 99 | ≤ 1 m | ||
ANTI-INFECTIVE MEDICATIO NS
|
51 (24%)
| ||||
Antibacterial agent
| Chloramphenicol | eye drops 0.5% | 7 | 1664 | ≤ 12 yrs |
Azithromycin | eye drops 1% | 1 | 335 | ≥ 1 yr | |
eye drops 1.5% | 2 | 542 | ≥ 1 yr | ||
Tetracycline | eye drops 1% | 2 | 518 | 1- 10 yrs | |
eye ointment 1% | 2 | 218 | ≥ 6 ms | ||
Besifloxacin | eye suspension 0.6% | 3 | 1124 | ≥ 1yr | |
Fusidic acid | eye drops 1% | 3 | 594 | ≤ 2 yrs | |
Moxifloxacin | eye drops 0.5% | 3 | 645 | all | |
Tobramycin | eye drops | 3 | 741 | ≤ 12 yrs | |
Ciprofloxacin | eye drops 0.3% | 2 | 193 | ≤ 12 yrs | |
Levofloxacin | eye drops 0.5% | 2 | 106 | 1-16 yrs | |
Gentamycin | eye ointment | 2 | 117 | ≤ 12 yrs | |
Erythromycin | eye drops | 1 | 110 | ≤ 1 m | |
eye ointment | 1 | 24 | ≤ 1 yr | ||
Ofloxacin | eye drops 0.3% | 1 | 23 | ≥2 yrs | |
Oxytetracycline | eye drops 1% | 1 | 450 | ≤ 1 m | |
Sulphacetamide | eye drops 10% | 1 | 14 | ≤ 1 m | |
Antibacterials combinations
| Polymixin B/Oxytetracycline | eye ointment | 2 | 132 | 2-10 yrs |
Polymixin B/Bacitracin | eye ointment | 1 | 66 | ≥ 1 m | |
Polymixin B/Trimethoprim | eye drops | 1 | 28 | all | |
Antibacterial agent + NSAID
| Gentamycin/Diclofenac | eye drops | 1 | 12 | ≤ 12 yrs |
Antibacterial agent + Steroid agent
| Neomycin/Betamethasone | eye drops | 1 | 12 | ≤ 12 yrs |
Tobramycin/Dexamethasone | eye drops | 1 | 28 | 4-10 yrs | |
Antifungal agents
| Miconazole | eye suspension 1% | 1 | 12 | ≥ 15 yr |
Econazole/Miconazole | eye suspension 1%/1% | 1 | 7 | ≥ 15 yr | |
Other anti-infective eye preparation
| Povidone-iodine | eye drops 2.5% | 4 | 3132 | ≤ 1 yr |
Silver nitrate | eye drops 1% | 1 | 450 | ≤ 1 m | |
ANTI-ALLERGY MEDICATIONS
|
31 (15%)
| ||||
Anti-histamine agent
| Levocabastine | eye suspension 0.5% | 6 | 174 | ≥ 3 yrs |
Ketotifen | eye drops 0.025% | 5 | 522 | ≥ 3 yrs | |
Olopatadine | eye drops 0.2% | 4 | 99 | ≥ 3 yrs | |
Azelastine | eye drops 0.02% | 4 | 132 | ≥ 4 yrs | |
Bepotastine | eye drops 1% | 1 | 36 | ≥ 10 yrs | |
eye drops 1.5% | 1 | 36 | ≥ 10 yrs | ||
Emedastine | eye drops 0.05% | 1 | - | 3-16 yrs | |
Mast cell stabilizer
| Lodoxamide | eye drops 0.1% | 1 | 15 | ≥ 6 yrs |
Cromoglycate | eye drops 2% | 4 | 128 | ≥ 4 yrs | |
eye drops 4% | 1 | 30 | ≥ 16 yrs | ||
Nedocromil | eye drops 2% | 3 | 85 | ≥ 4 yrs | |
ANTI-INFLAMMATORY MEDICATIONS
|
18 (9%)
| ||||
Corticosteroid
| Dexamethasone | eye drops 0.1% | 6 | 159 | all |
Fluorometholone | eye drops 0.1% | 3 | 52 | ≤ 10 yrs | |
Rimexolone | eye drops 1% | 1 | 22 | 4 - 8 yrs | |
NSAID
| Diclofenac | eye drops 0.1% | 4 | 93 | ≥ 2 yrs |
Ketorolac | eye drops 0.5% | 3 | 70 | ≤ 12 yrs | |
Flurbiprofen | eye drops | 1 | 50 | ≥ 5 yrs | |
ANTIGLAUCOMA MEDICATIONS
|
10 (5%)
| ||||
Beta-blocker
| Timolol | eye drops 0.25% | 2 | 44 | 7-13 yrs |
eye drops 0.5% | 1 | 12 | ≥ 14 yrs | ||
gel-forming solution 0.25% | 1 | 35 | ≤ 6yrs | ||
gel-forming solution 0.5% | 1 | 36 | ≤ 6yrs | ||
Betaxolol | eye suspension 0.25% | 1 | 52 | ≤ 6 yrs | |
Levobetaxolol | eye suspension 0.5% | 1 | 46 | ≤ 6 yrs | |
Carbonic anhydrase inhibitor
| Brinzolamide | eye suspension 1% | 1 | 32 | ≤ 6 yrs |
Dorzolamide | eye drops 2% | 1 | 56 | ≤ 6 yrs | |
Acetylcholinesterase inhibitor
| Echothophate iodide | eye drops | 1 | 20 | - |
PERI-OPERATIVE MEDICATIONS
|
18 (9%)
| ||||
Local anaesthetic agent
| Bupivacaine | subconjuntival infiltration | 2 | 38 | 5-10 yrs |
eye drops 0.5% | 1 | 17 | 3-6 yrs | ||
Proparacaine | eye drops 0.5% | 3 | 58 | ≤ 1 m | |
Lidocaine | eye drops 2% | 1 | 10 | 3 - 14 yrs | |
ophthalmic gel 2% | 1 | 24 | 3-12 yrs | ||
Amethocaine | eye drops 0.5% | 2 | 45 | 2 - 8 yrs | |
Levobupivacaine | eye drops | 1 | 13 | 1 - 16 yrs | |
Oxybuprocaine | eye drops 0.4% | 1 | 20 | 3-8 yrs | |
Tetracaine | eye drops 1% | 1 | 44 | 1-12 yrs | |
Sucrose | eye drops | 1 | 11 | ≤1 m | |
Chemotherapeutic agents
| Mitomicyn C | eye drops 0.02% | 1 | 10 | ≥ 6 yrs |
ocular injection 0.4% | 1 | 7 | ≥ 6 yrs | ||
5-fluorouracil | ocular injection | 1 | 4 | ≤ 12 yrs | |
Mitomicyn C/5-fluorouracil | ocular injection | 1 | 4 | ≤ 12 yrs | |
OTHER DRUGS
|
7 (3%)
| ||||
Vernal keratoconjunctivitis
| Cyclosporine | eye drops 2% | 1 | 14 | 5-16 yrs |
eye drops 1.25% | 1 | 20 | 5-14 yrs | ||
eye drops 1% | 1 | 32 | 5-14 yrs | ||
Mipragoside | ophthalmic gel 0.5% | 1 | 12 | 5-20 yrs | |
ROP therapy
| Bevacizumab | intravitreal injection | 1 | 7 | ≤ 1 m |
Esotropia
| Botulinum toxin | ocular injection | 1 | 27 | 6-12 yrs |
Dacryocystitis
| Herba houttuyaniae | eye drops | 1 | 268 | ≤ 1 m |
TOTAL (69 single drugs & combinations)
|
209
|
18,816
|
Guidelines
Ref. | Organisation | Title | Disease | Quality of evidence | Treatment (Licensing status) | Country | Year |
---|---|---|---|---|---|---|---|
[41] | National Guideline Clearinghause (NGC) | Guidelines for the treatment and management of acute bacterial conjunctivitis in children and adults. | Acute bacterial conjunctivitis | I | Topical antibiotic therapy: • Norfloxacin 0.3% (nl) • Ciprofloxacin 0.3% • Ofloxacin 0.3% • Levofloxacin 0.5% (nl UK, nl USA) • Lomefloxacin 0.3% • Moxifloxacin 0.5% (nl UK) • Gatifloxacin 0.3% (nl IT, nl UK) • Chloramphenicol 0.5% (nl USA)
• Sulfacetamide Sodium 10% (nl)
• Erythromycin 0.5% (nl)
• Gentamicin Sulfate 0.3% (nl)
• Trimethoprim Sulfate/Polymyxin B 10000 U/1 mg/mL (nl IT)
• Fusidic acid 0.1% (nl IT, nl USA)
• Tobramycin 0.3% (nl UK, nl USA)
• Povidone-iodine 1.25% (nl UK, nl USA)
• Bacitracin (nl)
Ocular steroids and steroid-antibiotic: • Prednisolone (nl IT, nl USA)
• Fluorometholone 0.1%/sulfacetamide sodium 10% (nl)
• Fluorometholone 0.1% • Neomycin/polymyxin B/dexamethasone 0.1% (nl IT)
• Gentamicin 0.3%/prednisolone acetate 0.1% (nl)
• Tobramycin 0.3%/dexamethasone 0.1% (nl)
| USA | 2005 |
[34] | Canadian Paediatric Society | Recommendations for the prevention of neonatal ophthalmia | Prophylaxis to prevent neonatal ophthalmia due to N gonorrhoeae | III | • Silver nitrate 1% eye drops (nl)
• Erythromycin 0.5% ointment (nl)
• Tetracycline 1% ointment (nl)
| Canada | 2002 (Rev. 2009) |
[29] | Moore W. and Nischal K.K. | Pharmacologic management of glaucoma in childhood | Glaucoma | I | • Β-Blockers: Betaxolol 0.25% (nl)
• Carbonic Anhydrase Inhibitors: Dorzolamide 2% (nl UK, nl USA)
• Prostaglandin Analogs: Latanoprost (nl), Travoprost (nl), Bimatoprost (nl)
• Adrenoceptor Agonists: Brimonidine (nl UK), Apraclonidine (nl)
• Parasympathomimetics: Pilocarpine (nl UK, nl USA)
| UK | 2007 |
[39] | Royal College of Ophthalmologists | Guidelines for the management of amblyopia | Ambliopia | III | • Refractive correction (glasses) • Patching: from 2 to 6 hours per day • Atropine (nl IT, nl USA)
| UK | 2006 |
[6] | National Guideline Clearinghause (NGC) | Best evidence statement (BESt). Treatment of amblyopia in children. | Amblyopia | I | • Refractive correction (glasses) • Atropine: 1 drop/day, 2 - 7 days per week (nl IT, nl USA)
• Patching: from 2 to 6 hours per day | USA | 2007 |
[38] | Royal College of Ophthalmologists | Guidelines for the management of strabismus in childhood | Strabismus | III | • Surgical interventions • Refractive correction (glasses) • Miotics (not specified) | UK | 2007 |
[46] | The Brazilian Society of Pediatrics, Brazilian Council of Ophthalmology, Brazilian Society of Pediatric Ophthalmology | Brazilian guidelines proposal for screening and treatment of retinopathy of prematurity (ROP) | Retinopathy of prematurity (ROP) | III | Surgical interventions+post surgical treatment with topical steroids/antibiotics (not specified) | Brazil | 2007 |
[40] | Royal College of Ophthalmologists, Royal College of Paediatrics and Child Health, British Association of Perinatal Medicine & BLISS | Guideline for the Screening and Treatment of Retinopathy of Prematurity | Retinopathy of prematurity (ROP) | III | Screening examination with Cyclopentolate 0.5%/Phenylephrine 2.5% combination: 1drop each in 2 to 3 doses, each 5 minutes apart, 1 hour prior to examination (nl) | UK | 2008 |