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Impact of antibiotic resistance in the management of ocular infections: the role of current and future antibiotics

Authors Bertino JS

Published 16 September 2009 Volume 2009:3 Pages 507—521


Review by Single-blind

Peer reviewer comments 3

Joseph S Bertino Jr1,2

1College of Physicians and Surgeons, Columbia University, New York, N Y, USA; 2Principal, Bertino Consulting, Schenectady, NY, USA

Purpose: This article reviews the effects of the increase in bacterial resistance on the treatment of ocular infections.

Design: Interpretive assessment.

Methods: Literature review and interpretation.

Results: Ocular bacterial infections include conjunctivitis, keratitis, endophthalmitis, blepharitis, orbital cellulitis, and dacryocystitis. Treatment for most ocular bacterial infections is primarily empiric with broad-spectrum antibiotics, which are effective against the most common bacteria associated with these ocular infections. However, the widespread use of broad-spectrum systemic antibiotics has resulted in a global increase in resistance among both Gram-positive and Gram-negative bacteria to a number of the older antibiotics as well as some of the newer fluoroquinolones used to treat ophthalmic infections. Strategies for the prevention of the increase in ocular pathogen resistance should be developed and implemented. In addition, new antimicrobial agents with optimized pharmacokinetic and pharmacodynamic properties that have low toxicity, high efficacy, and reduced potential for the development of resistance are needed.

Conclusions: New antimicrobial agents that treat ocular infections effectively and have a low potential for the development of resistance could be a part of strategies to prevent the global increase in ocular pathogen resistance.

Keywords: ocular infections, emerging pathogen drug resistance, fluoroquinolones, besifloxacin

General overview

While antibiotics are life-saving for many people, their overuse, incorrect use and underdosing have led to the development of resistant bacteria. Infections in the eye (conjunctivitis or pink eye) can be seen in both children and adults. While the infection will go away on its own, the use of antibiotic eye drops can speed up this process and reduce the chance of others getting this infection. Besifloxacin (Besivance®; Bausch and Lomb) is a new antibiotic that is used to treat conjunctivitis. Some advantages of besifloxacin include its high activity against other antibiotic-resistant bacteria that cause conjunctivitis, and its availability in a drop that stays on the eye for a prolonged period, helping the antibiotic to be effective. Besifloxacin is given in the eye three times a day for a total of 7 days and should be used for the full 7 days to reduce the risk of developing resistant bacteria.

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