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

Abstract

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: besifloxacin; emerging pathogen drug resistance; fluoroquinolones; ocular infections.

Figure 1

Percentage of S. aureus isolates resistant to methicillin (MRSA rate) according to specimen source (2000 to 2005 based on TSN database analysis). Reproduced with permission from Asbell PA, Sahm DF, Shaw M, Draghi DC, Brown NP. Increasing prevalence of methicillin resistance in serious ocular infections caused by Staphylococcus aureus in the United States: 2000 to 2005. J Cataract Refract Surg. 2008;34(5):814–818. Copyright © 2008 Elsevier.

Figure 2

S. pneumoniae susceptibility in ocular isolates by drug from the Ocular Tracking Resistance in the U.S. Today (TRUST 1) longitudinal surveillance program, 1999 through 2006. Reproduced with permission from Asbell PA, Colby KA, Deng S, et al. Ocular TRUST: nationwide antimicrobial susceptibility patterns in ocular isolates. Am J Ophthalmol. 2008;145(6):951–958. Copyright © 2008 Elsevier.