Vol 6 (2021): Continuous Publishing
Review paper
Published online: 2021-11-26

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Antibiotic resistance in ophthalmology

Dominika Nowakowska1, Karolina Krix-Jachym, Marek Rękas, Edward Wylęgała
Ophthalmol J 2021;6:117-123.


Antibiotic resistance is a very serious medical problem. In ophthalmology, it is still unnoticed and underestimated. Although antibiotic drops appear to be harmless, their inappropriate use may increase resistance in some bacteria. Many recommendations emphasize the importance of the correct use of antibiotics — according to the guidelines, antibiotic therapy should be intensive and short-term. Rational administration of antimicrobial drugs is essential when eye-threatening severe conditions such as endophthalmitis need to be prevented or treated.

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  1. Antimicrobial resistance. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance (26 May 2021).
  2. D'Costa VM, King CE, Kalan L, et al. Antibiotic resistance is ancient. Nature. 2011; 477(7365): 457–461.
  3. Cassini A, Högberg L, Plachouras D, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infec Dis. 2019; 19(1): 56–66.
  4. Barry P, Cordovés L, Gardner S. ESCRS Guidelines for Prevention and Treatment of Endophthalmitis Following Cataract Surgery: Prevention and Treatment Endophthalmitis. European Society for Cataract & Refractive Surgeons, Dublin 2013.
  5. MacGowan A, Macnaughton E. Antibiotic resistance. Medicine. 2017; 45(10): 622–628.
  6. Vester B, Douthwaite S. Macrolide resistance conferred by base substitutions in 23S rRNA. Antimicrob Agents Chemother. 2001; 45(1): 1–12.
  7. O’Neill J. Tackling Drug-Resistant Infections Globally: Final Report And Recommendations The Review On Antimicrobial Resistance. https://amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf.
  8. Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. PT. 2015; 40(4): 227–283.
  9. Jackson TL, Johnston RL, Donachie PHJ, et al. The Royal College of Ophthalmologists' National Ophthalmology Database Study of Vitreoretinal Surgery: Report 6, Diabetic Vitrectomy. JAMA Ophthalmol. 2016; 134(1): 79–85; quiz 120.
  10. Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg. 2007; 33(6): 978–988.
  11. Postępowanie okołooperacyjne w chirurgii zaćmy Wytyczne Polskiego Towarzystwa Okulistycznego. Stan na dzień 10 czerwca 2014. https://adst.mp.pl/s/www/okulistyka/wytyczne_PTO_chirurgia_zacmy_2014.pdf.
  12. Lindstrom RL, Galloway MS, Grzybowski A, et al. Dropless Cataract Surgery: An Overview. Curr Pharm Des. 2017; 23(4): 558–564.
  13. Chang DF, Braga-Mele R, Henderson BAn, et al. ASCRS Cataract Clinical Committee. Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: Results of the 2014 ASCRS member survey. J Cataract Refract Surg. 2015; 41(6): 1300–1305.
  14. Hecht I, Karesvuo P, Achiron A, et al. Anti-inflammatory Medication After Cataract Surgery and Posterior Capsular Opacification. Am J Ophthalmol. 2020; 215: 104–111.
  15. Krupin T, Mandell AI, Podos SM, et al. Topical corticosteroid therapy and pituitary-adrenal function. Arch Ophthalmol. 1976; 94(6): 919–920.
  16. Singh R, Alpern L, Jaffe GJ, et al. Evaluation of nepafenac in prevention of macular edema following cataract surgery in patients with diabetic retinopathy. Clin Ophthalmol. 2012; 6: 1259–1269.
  17. Hooper DC. Mechanisms of action and resistance of older and newer fluoroquinolones. Clin Infect Dis. 2000; 31 Suppl 2: S24–S28.
  18. King DE, Malone R, Lilley, SH. New Classification and Update on the Quinolone Antibiotics. Am Fam Physician. 2000; 61(9): 2741–2748.
  19. Liu HH. Safety profile of the fluoroquinolones: focus on levofloxacin. Drug Saf. 2010; 33(5): 353–369.
  20. Schwab I, Friedlaender M, McCulley J, et al. A phase III clinical trial of 0.5% levofloxacin ophthalmic solution versus 0.3% ofloxacin ophthalmic solution for the treatment of bacterial conjunctivitis. Ophthalmology. 2003; 110(3): 457–465.
  21. Ross D, Elkinton S, Riley C. Physicochemical properties of the fluoroquinolone antimicrobials. III. 1-Octanol/water partition coefficients and their relationships to structure. Int J Pharm. 1992; 88(1-3): 379–389.
  22. Sakamoto H, Sakamoto M, Hata Y, et al. Aqueous and vitreous penetration of levofloxacin after topical and/or oral administration. Eur J Ophthalmol. 2007; 17(3): 372–376.
  23. Osato M, Jensen H, Trousdale M, et al. The Comparative In Vitro Activity of Ofloxacin and Selected Ophthalmic Antimicrobial Agents Against Ocular Bacterial Isolates. Am J Ophthalmol. 1989; 108(4): 380–386.
  24. Raizman M, Rubin J, Graves A, et al. Tear concentrations of levofloxacin following topical administration of a single dose of 0.5% levofloxacin ophthalmic solution in healthy volunteers. Clin Ther. 2002; 24(9): 1439–1450.
  25. Keating GM. Moxifloxacin 0.5% ophthalmic solution: in bacterial conjunctivitis. Drugs. 2011; 71(1): 89–99.
  26. Winfield AJ, Jessiman D, Williams A, et al. A study of the causes of non-compliance by patients prescribed eyedrops. Br J Ophthalmol. 1990; 74(8): 477–480.
  27. Kholdebarin R, Campbell R, Jin YP, et al. Multicenter study of compliance and drop administration in glaucoma. Can J Ophthalmol. 2008; 43(4): 454–461.
  28. An JA, Kasner O, Samek DA, et al. Evaluation of eyedrop administration by inexperienced patients after cataract surgery. J Cataract Refract Surg. 2014; 40(11): 1857–1861.
  29. Considerations in glaucoma therapy: fixed combinations versus their component medications. Clin Ophthalmol. 2009: 1.
  30. Figus M, Posarelli C, Romano D, et al. Aqueous humour concentrations after topical apPlication of combinEd levofloxacin-dexamethasone eye dRops and of its single components: a randoMised, assEssor-blinded, parallel-group study in patients undergoing cataract surgery: the iPERME study. Eur J Clin Pharmacol. 2020; 76(7): 929–937.
  31. Levo-Dexa vs. Tobra+Dexa for Prevention and Treatment of Inflammation and Prevention of Infection in Cataract Surgery. https://clinicaltrials.gov/ct2/show/NCT03739528 (25 June 2021).