Eye bacterial infections include conjunctivitis,keratitis, endophthalmitis,preseptal cellulitis,orbital cellulitis, and dacryocystitis.Broad spectrum antibiotics are the choice of treatment.These are effective against the most common bacteria associated with these ocular infections. However, the widespread use of broad-spectrum systemic antibiotics has resulted in resistance among both Gram-positive and Gram-negative bacteria to a number of the older antibiotics used to treat ophthalmic infections.
A recently published study from India has shown a link between in vitro resistance and clinical failure to respond in patients with keratitis caused by Pseudomonas isolates. Garg et al(Ophthalmology 1999;106:1319-2)reported that of 141 culture-proven cases of Pseudomonas keratitis, 22 cases were caused by isolates resistant to ciprofloxacin (mean MIC 43mg/ml). Of the 19 (of 22) cases treated initially with ciprofloxacin, 15 (76.7 per cent) worsened or showed no clinical improvement after three days of intensive therapy and required modification of antibiotic therapy, corneal grafting or evisceration (surgical removal of the contents of the eyeball).
Broad-spectrum, bactericidal antibiotics and its resistance is becoming a greater problem in managing ocular bacterial infections.The fourth-generation fluoroquinolones with broader gram-positive coverage and greater effectiveness against emerging resistant isolates are now available for ophthalmic use.
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