Characterization of Polybacterial versus Monobacterial Conjunctivitis Infections in Pediatric Subjects Across Multiple Studies and Microbiological Outcomes with Besifloxacin Ophthalmic Suspension 0.6%

Abstract

Introduction

The choice of empiric therapy for bacterial conjunctivitis should be guided by an awareness of typical causative pathogen distributions. Bacterial conjunctivitis can be polybacterial, although pediatric-specific data are lacking.

Methods

This was a post-hoc analysis of data in pediatric subjects (1–17 years) from five bacterial conjunctivitis trials evaluating besifloxacin ophthalmic solution 0.6%.

Results

Of the 730 pediatric subjects with culture-confirmed conjunctivitis, nearly one-fourth (23.6%) had polybacterial infections and three-fourths (76.4%) had monobacterial infections at baseline. In both polybacterial and monobacterial infections, the most prevalent organisms were Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, and Streptococcus mitis/S. mitis group. In polybacterial versus monobacterial infections, S. mitis/S. mitis group (8.7% vs 4.3%; P=0.032) and Moraxella catarrhalis (4.7% vs 0.5%; P<0.001) were identified more frequently, whereas S. pneumoniae (14.0% vs 28.1%; P<0.001) was identified less frequently, as the dominant infecting species. MICs for individual species were similar for tested antibiotics regardless of polybacterial or monobacterial infection, except Staphylococcus epidermidis for which fluoroquinolone MICs were ≥3 dilutions higher for isolates of this species sourced from polybacterial compared to monobacterial infections. Treatment with besifloxacin resulted in microbial eradication in 79.1% of polybacterial and 92.3% of monobacterial infections (P≤0.005 vs vehicle).

Discussion

One in four pediatric bacterial conjunctivitis infections is polybacterial, highlighting the need for a broad-spectrum antibiotic when choosing empiric therapy.

Keywords:

• pediatric
• conjunctivitis
• polybacterial
• besifloxacin
• minimum inhibitory concentration

Acknowledgments

Medical writing assistance was provided by Churchill Communications (Maplewood, NJ), funded by Bausch + Lomb (a division of Bausch Health, LLC). Statistical analysis was conducted by H. Proskin, funded by Bausch + Lomb. Portions of this paper were presented at the American Academy of Pediatrics Virtual 2020 National Conference & Exhibition as a poster presentation with interim findings. The poster’s abstract was published in Pediatrics March 2021, 147 (3 MeetingAbstract) 296: https://doi.org/10.1542/peds.147.3_MeetingAbstract.296.

Author Contributions

JM Blondeau and HH DeCory contributed to the interpretation of the data, HM Proskin contributed to the analysis of the data, and CM Sanfilippo contributed to the analysis and interpretation of the data. JM Blondeau contributed to the study conception, HH DeCory contributed to the study design, and HM Proskin and CM Sanfilippo contributed to both the study design and conception. All authors made substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval for the version to be published; and agreed to be accountable for all aspects of the work.

Disclosure

HH DeCory & CM Sanfilippo are employees of Bausch Health US, LLC. Statistical analysis was conducted by HM Proskin, funded by Bausch Health US, LLC. JM Blondeau has received independent research grants from Bausch Health US, LLC. The authors report no other conflicts of interest in this work.

Additional information

Funding

The original studies included in this pooled analysis were funded by Bausch & Lomb Incorporated and involved the marketed product Besivance^® (besifloxacin ophthalmic suspension, 0.6%).