Fluoroquinolone and fortified antibiotics for treating bacterial corneal ulcers

Abstract

This finding may have resulted from quicker clinical response of healing as a result of less toxicity found in the patients treated with fluoroquinolone. However, as some serious complications were encountered more commonly in the fluoroquinolone group, caution should be exercised in using fluoroquinolones in large, deep ulcers in the elderly. (Br J Ophthalmol 2000;84:378-384) The accepted treatment for severe bacterial corneal ulcers includes frequent administration of fortified topical ocular antibacterial agents (usually a cephalosporin and an aminoglycoside) used together to cover the maximum spectrum of bacteria. Treatment is modified according to host clinical response and laboratory susceptibility data concerning the organism(s) along with decisions regarding adjunctive therapy.

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

“…If the patient's ulceration progresses to the point that a perforation is imminent, then corneal transplantation surgery or amniotic membrane graft may be indicated [45,69]. Prevention of ulceration is therefore critically important in patients with EK; for prophylaxis, the use of bandage contact lenses and concurrent broad-spectrum antibiotics can help decrease the incidence of this morbidity [49,53]. Treating providers must remember that the above procedures can be a source of…”

“…Moving further along the continuum of acuity, eyelid swelling, conjunctival swelling with hyperemia, and eyelid crusting or discharge are the primary signs of infection in an ICU patient [3,37,47,48]. Slit lamp examination typically shows evidence of the presence of bacterial corneal ulcer while penlight examination reveals ulcerated corneal epithelium with a gray or white infiltrate [16,49,50].…”

A Mucoadhesive Polymer Extracted from Tamarind Seed Improves the Intraocular Penetration and Efficacy of Rufloxacin in Topical Treatment of Experimental Bacterial Keratitis

“…Rufloxacin is administered orally and displays a long half-life in plasma (28 to 30 h), consistently high bactericidal concentrations at the site of infection, and good penetration into infected tissues and cerebrospinal fluid (24,31). To evaluate the intraocular penetration and therapeutic benefit of rufloxacin, whether delivered by TSP or not, an experimental model of P. aeruginosa and S. aureus keratitis in rabbits was developed; the drug efficacy was then compared with that of ofloxacin, which is commonly used for the topical therapy of this ocular pathology (13,26,29).…”

“…On the other hand, topical treatment may fail to achieve therapeutically active drug levels in the cornea, as continuous tear flow reduces the bioavailability of topically applied antibiotics and the corneal epithelium acts as a barrier against drug penetration. For this reason, standard treatment of severe bacterial keratitis requires administration at frequent intervals (every 15 to 60 min for 48 to 72 h) of eyedrops often containing fortified (more concentrated than commercially available solutions) solutions of fluoroquinolones or multiple antibiotics, usually a cephalosporin and an aminoglycoside (7,13,28,29). However, this regimen not only is disruptive to the patient and usually necessitates hospitalization, but it has also been associated with in vitro toxicity to the corneal epithelium (9,22).…”

Postantibiotic Effects and Bactericidal Activities of Levofloxacin and Gatifloxacin at Concentrations Simulating Those of Topical Ophthalmic Administration against Fluoroquinolone-Resistant and Fluoroquinolone-Sensitive Methicillin-Resistant Staphylococcus aureus Strains

“…Indeed, the frequent administration of eye drops containing GAT has successfully been used to treat moderately or highly resistant S. aureus strains (MICs, 12 g/ml and Ͼ64 g/ml, respectively) in a rabbit keratitis model (26). However, high concentrations of fluoroquinolones can cause corneal perforations in humans (7,16,32). We did not investigate how the growth-inhibitory effects of long-duration supra-MIC and sub-MIC dosages of antibiotics following brief exposure to a high concentration of the antibiotic affected the antibacterial responses.…”