Is Antibiotic Resistance a Problem in the Treatment of Ophthalmic Infections?

Regis P Kowalski

Disclosures

Expert Rev Ophthalmol. 2013;8(2):119-126. 

In This Article

The Availability of Effective Antibiotic Therapy

Laboratory studies that include culture isolation and antibiotic susceptibility testing, are crucial to ensure effective therapy with the most potent drug. Vancomycin is the most effective antibiotic to treat endophthalmitis due to Gram-positive bacteria. The addition of amikacin or ceftazidime supplements the treatment of Gram-negative bacteria while complementing the therapy of Gram-positive infection. The use of second-generation fluoroquinolone anti-infectives should be refrained from, especially in the light of fluoroquinolone usage in surgical prophylaxis. The risk of vancomycin resistance is minimal.

In an in vitro study by our laboratory, we tested 100 bacteria isolated from keratitis based on historical incidence (Figure 2). The bacterial keratitis isolates were tested for MIC determination to cefazolin, tobramycin, cefuroxime, gentamicin and moxifloxacin. Fortified combinations of cefazolin and tobramycin, cefuroxime and gentamicin and moxifloxacin were found to be equivalent for the empiric treatment of bacterial keratitis (Figure 13). Along with laboratory studies, effective therapy and the use of the most potent antibiotics could circumvent any possible resistance to be treated or developed.[24]

Figure 13.

The in vitro coverage of 100 bacterial isolates based on historical incidence to combination fortified antibiotics and monotherapy with a fourth-generation fluoroquinolone.

Bacterial conjunctivitis is a self-limiting infection that does not require treatment for resolution, but topical antibiotics can speed resolution to a timely conclusion, which could reduce time away from school and work. There are an abundance of topical antibiotics that enter the ophthalmic market as a conjunctivitis indication and demonstrate effective proficiency.

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