Twenty RCTs (n=3,289) were included in the review and 18 RCTs (n=3,159) were included in the meta-analyses.
The Jadad scores ranged from 1 to 5 (median 2). Only 2 studies scored the maximum of 5 points.
Compared with placebo, antimicrobials (neomycin/methylprednisolone and acetic acid/glyceryl triacetate) were associated with a significant increase in clinical cure rate at 3 to 10 days (RD 0.46, 95% CI: 0.29, 0.63, p<0.001; 2 RCTs, n=89) and bacteriological cure rate (RD 0.61, 95% CI: 0.46, 0.76, p<0.001; 2 RCTs, n=112). No statistically significant heterogeneity was detected (I-squared 0 for both meta-analyses). The studies were conducted by the same authors and were of high quality (both Jadad scores were 4 and both studies were double-blinded).
Compared with steroid alone (betamethasone and hydrocortisone butyrate), steroid-antibiotic combinations (oxytetracycline/polymyxin B/hydrocortisone) were associated with a significant decrease in clinical cure rate at 7 to 11 days (RD -0.20, 95% CI: -0.38, -0.03, p=0.021; 2 RCTs, n=92).
Quinolone antibiotics (ofloxacin, ciprofloxacin with and without dexamethasone or hydrocortisone) were associated with a significant increase in bacteriological cure rate compared with nonquinolone antibiotics (gentamicin, tobramycin, polymyxin/hydrocortisone plus neomycin and oxytetracycline), (RD 0.08, 95% CI: 0.006, 0.16, p=0.035; 6 RCTs, n=980). Significant heterogeneity was found (I-squared 74%). The difference between treatments was no longer significant after the exclusion of one small study with an RD at least twice that of the other studies, but heterogeneity remained significant (p=0.021). There were no significant differences in clinical cure rates and adverse events between quinolone antibiotics and nonquinolone antibiotics, based on analyses of between 476 and 1475 patients from between 2 and 6 studies. Significant heterogeneity was found in most of these analyses.
There were no significant differences between antiseptic versus antimicrobial treatments and steroid-antimicrobial combinations versus antimicrobial alone.