Levofloxacin and Tobramycin for Severe Bacterial Keratouveitis

Accorinti, Massimo; Colao, Lorena; Gilardi, Marta; Cecere, Michela; Salotti, Alessandra; Pesci, Francesca Romana

doi:10.3109/09273948.2015.1010093

Cited by 3 publications

(5 citation statements)

References 50 publications

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“…Tobramycin and fluoroquinolones are considered first-line drugs for the most common ocular infection, bacterial conjunctivitis [ 20 ]. Common organisms had similar susceptibility to levofloxacin and tobramycin, and these drugs had comparable efficacy in some ocular infections [ 21 , 22 ]. The continuously increasing use rate of levofloxacin should be noticed.…”

Section: Discussionmentioning

confidence: 99%

Trends in Outpatient Prescribing Patterns for Ocular Topical Anti-Infectives in Six Major Areas of China, 2013–2019

Zhu

Jin

et al. 2021

Antibiotics

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Topical anti-infectives are important in the management of ocular infections, but little is known about their current status and trends in their use in China. Thus, we carried out a prescription-based, cross-sectional study using the database of Hospital Prescription Analysis Projection of China, and aimed to analyze the trend in the use of ocular topical anti-infectives for outpatients of the ophthalmology department from 2013 to 2019. A total of 2,341,719 prescriptions from 61 hospitals located in six major areas written by ophthalmologists for outpatients were identified, and 1,002,254 of the prescriptions contained at least one anti-infective. The yearly anti-infective prescriptions increased continuously from 126,828 prescriptions in 2013 to 163,434 prescriptions in 2019. The cost also increased from 4,503,711 Chinese Yuan (CNY) in 2013 to CNY 5,860,945 in 2019. However, the use rate of anti-infectives decreased slightly from 46.5% in 2013 to 41.1% in 2019. Patients aged between 19 and 45 years old had the highest anti-infective use rate. Levofloxacin was the most frequently used anti-infective and kept on increasing among all age groups, occupying 67.1% of the total cost at the end of the study. Tobramycin was more frequently used in pediatric patients than in adults, but the use still decreased. Ganciclovir was the preferred anti-viral drug over acyclovir. In conclusion, the prescriptions and cost of ocular topical anti-infectives for outpatients both increased progressively. The increasingly widespread use of levofloxacin raised concerns regarding safety in pediatrics and resistance development. The observed trends can lead to the more efficient management of ocular anti-topical anti-infectives in China.

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Section: Discussionmentioning

confidence: 99%

Trends in Outpatient Prescribing Patterns for Ocular Topical Anti-Infectives in Six Major Areas of China, 2013–2019

Zhu

Jin

et al. 2021

Antibiotics

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“…Based on the extent and depth of corneal opacity, the clinical scores on mouse eyes were obtained (Figure 4D ). Kanamycin alone and MomL alone showed no therapeutic effect, while the treatment effect of MomL‐kanamycin was significant and was close to the effect of the tobramycin control (the commonly used clinical antibiotic for the treatment of bacterial keratitis 43 ) (Figure 4D ). The results of HE staining (Figure 4E ) of the corneal slices were consistent with the clinical scores.…”

Section: Resultsmentioning

confidence: 58%

“…Pseudomonas aeruginosa ( P. aeruginosa ) is a multidrug‐resistant facultative pathogen and has been listed as a key priority bacterium by the World Health Organization 1 , and has been recognized as an opportunistic pathogen that is the most common bacterium associated with nosocomial infections, ocular surface inflammation, and ventilator‐associated pneumonia 2 . Empirical antibiotic therapy, such as tobramycin and levofloxacin 3 , improves the cure rate of severe P. aeruginosa infections. However, excessive use of antibiotics during treatment accelerates the development of multidrug‐resistant P. aeruginosa strains, leading to the ineffectiveness of empirical antibiotic therapy against this microorganism 4 .…”

Section: Introductionmentioning

confidence: 99%

MomL inhibits bacterial antibiotic resistance through the starvation stringent response pathway

Dou

Yuan

et al. 2022

mLife

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Antibiotic resistance in gram-negative pathogens has become one of the most serious global public health threats. The role of the N-acyl homoserine lactone (AHL)-mediated signaling pathway, which is widespread in gram-negative bacteria, in the bacterial resistance process should be studied in depth. Here, we report a degrading enzyme of AHLs, MomL, that inhibits the antibiotic resistance of Pseudomonas aeruginosa through a novel mechanism. The MomL-mediated reactivation of kanamycin is highly associated with the relA-mediated starvation stringent response. The degradation of AHLs by MomL results in the inability of LasR to activate relA, which, in turn, stops the activation of downstream rpoS. Further results show that rpoS directly regulates the type VI secretion system H2-T6SS. Under MomL treatment, inactivated RpoS fails to regulate H2-T6SS; therefore, the expression of effector phospholipase A is reduced, and the adaptability of bacteria to antibiotics is weakened. MomL in combination with kanamycin is effective against a wide range of gram-negative pathogenic bacteria. Therefore, this study reports a MomL-antibiotic treatment strategy on antibiotic-resistant bacteria and reveals its mechanism of action.

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“…Accorinti et al 9 described the clinical features and outcomes of a series of 20 consecutive patients who presented to the emergency department at the Sapienza University of Rome, Italy, with severe, unilateral central, or paracentral bacterial corneal ulcers associated with dense and deep corneal stromal infiltration and moderate to severe (2+) anterior chamber reaction, hence keratouveitis. All were treated with combined intensive topical levofloxacin (5 mg/mL) and tobramycin (0.3%) plus oral levofloxacin (1 g daily).…”

mentioning

confidence: 99%

“…[6][7][8] Even with these established and emerging approaches, however, corneal infections remain a therapeutic challenge. Three original articles [9][10][11] in this issue of Ocular Immunology & Inflammation (OII) address adjunctive approaches to the treatment of infectious keratitis.…”

mentioning

confidence: 99%

Treating Infectious Keratitis

Cunningham

Acharya

Akpek

et al. 2016

Ocular Immunology and Inflammation

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Levofloxacin and Tobramycin for Severe Bacterial Keratouveitis

Abstract: Pseudomonas aeruginosa is the most frequent cause of bacterial keratouveitis and CL wear the most common risk factor. Topical tobramycin and levofloxacin and oral levofloxacin are effective in the treatment of bacterial keratouveitis.

Cited by 3 publications

References 50 publications

Trends in Outpatient Prescribing Patterns for Ocular Topical Anti-Infectives in Six Major Areas of China, 2013–2019

Trends in Outpatient Prescribing Patterns for Ocular Topical Anti-Infectives in Six Major Areas of China, 2013–2019

MomL inhibits bacterial antibiotic resistance through the starvation stringent response pathway

Treating Infectious Keratitis

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