Topical antibiotic therapy in eye infections - myths and certainties in the era of bacterial resistance to antibiotics

Abstract

Globally, the alarming increase in the rate of antibiotic (AB) resistance of bacteria is currently considered one of the 7 major threats to the human race along with terrorism, nuclear proliferation and pollution. Judicious use of AB by physicians in all medical and surgical specialties is essential to limit the extent of resistance to AB. In Europe, Romania ranks among the first in terms of the rate of resistance to AB of the main bacteria involved in eye infections (EI). The principles of a judicious antibiotic therapy in ophthalmology are: performing the bacteriological determinations necessary to establish the bacterium involved in EI and its sensitivity to AB; avoiding the treatment of viral infections with AB; knowledge of the local rate of resistance of bacteria to AB; first choice of an AB with a spectrum appropriate to the aetiology of EI; the chosen AB must penetrate well into the eye tissues; using the local route of administration whenever possible; avoiding sub-dosing and shortening the duration of antibiotic therapy; abandoning the "myth" that a "in vitro" bactericidal AB would be inherently more clinically effective ("in vivo") than a bacteriostatic AB; requesting the consultation of infectious diseases for EI with AB multidrug-resistant bacteria. The available ophthalmic topics contain antibiotics from the following classes: aminoglycosides, fluoroquinolones, chloramphenicol, glycopeptides, polymyxins, etc. The increase in the fluoroquinolone resistance rate of the bacteria involved in EI has recently led to the recommendation that, in the absence of the antibiogram, it is best to avoid first-line antibiotic therapy with topical fluoroquinolones alone in keratitis. Abbreviations: AB = antibiotic, AG = aminoglycosides, AUC = area under the curve, Cf = chloramphenicol, Cmax = maximum concentration in tears, CNS = central nervous system, CSF = cerebrospinal fluid, DNA = deoxyribonucleic acid, ECDC = European Centre for Disease Prevention and Control, EI = eye infections, ENT = ear, nose and throat, EU = European Union, FQ = fluoroquinolones, HSV = Herpes simplex virus, MBC = minimum bactericidal concentration, MIC = minimum inhibitory concentration, MRSA = methicillin-resistant S. aureus, MRSE = methicillin-resistant S. epidermidis, MSSA = methicillin-sensitive S. aureus, MSSE = methicillin-sensitive S. epidermidis, PCR = polymerase chain reaction, S = sulfonamides, SPC = summary of product characteristics, USA = United States of America, VZV = Varicella zoster virus.