The Threat of Bacterial Resistance and Its Implications for Eyecare

Discussion with directors of ocular microbiology laboratories and a review of published articles and presentations at major ophthalmology meetings (including the annual meetings of the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery and the Association for Research in Vision and Ophthalmology) document growing concern over steadily rising levels of bacterial resistance to current market-leading ophthalmic antibiotic drugs.

Bacterial resistance to these antibiotics can result in treatment failure, increased morbidity, and a greater financial burden on healthcare facilities. This is a concern to all who prescribe ocular antiinfective medications for either therapeutic or prophylactic reasons.

However, physicians can affect resistance levels by their drug-usage and drug-selection behaviors. Aimed at clinicians, this CME activity enduring material proposes to:

• Explore the mechanisms of bacterial resistance to antibiotics to develop a rationale for appropriate selection and use of prophylactic and therapeutic agents.
• Describe current patterns of resistance to the major ocular antibiotics.
• Evaluate possible changes in regimen and drug selection that may reduce the induction of resistance in susceptible species and provide patients with protection from resistant strains.

Within ophthalmology, the most widely used topical antibacterial agents (by far) are fluoroquinolones (moxifloxacin, gatifloxacin, levofloxacin, ofloxacin, and ciprofloxacin). As these are the most clinically relevant agents, this enduring material will focus on topical fluoroquinolones.

Off-label Use Statement: This work discusses off-label uses of antiinfective medications.

Learning Objectives:

• List the significant ocular pathogens that have shown increased levels of resistance to topical fluoroquinolone antibiotics.
• Describe two mechanisms by which bacteria are able to reduce the cidal effects of antibiotics.
• State at least three ophthalmic prescribing strategies that may minimize the development of resistance among clinically significant ocular pathogens.
• Discuss treatment strategies in situations where infection with resistant organisms is either suspected or known.

Faculty: Marguerite B. McDonald, MD, FACS