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Availability of broad therapeutic options does not negate need for prevention
 Michael D. DePaolis |
In June of this year the world was rocked by another flu outbreak. Originating in Mexico, the H1N1 influenza virus A subtype rapidly spread around the globe and was quickly classified as a pandemic by the World Health Organization. The H1N1 created public hysteria, closed schools and overwhelmed medical facilities and public health departments alike. To date, it has infected more than a quarter of a million individuals, resulting in more than 2,500 deaths.
Like many infections, H1N1 is spread by airborne dissemination (cough and sneeze), human-to-human contact and by inhabiting inanimate objects. While the H1N1 behaves much like other flus, it is especially daunting in one respect – its genetic makeup.
The H1N1 has been referred to as a “genetic hybrid,” being composed of elements of four different flu viruses – one endemic to humans, one endemic to birds and two endemic to pigs. It is the genetic makeup that – at least partially – has been implicated in the H1N1’s rapid spread and wide spectrum of clinical presentation. It is also why creating an effective H1N1 vaccine is so challenging.
While the H1N1 results in no unusual ocular manifestations, it does cause us – and all health care providers – to pause, as it is a sobering reminder of how easily infections spread and how difficult their management can be. Simply put, just when we think we are well equipped with anti-infectives, along comes another bug to humble us … another bug, which – by virtue of its ability to morph, mutate and reinvent itself – thwarts our therapeutic efforts.
In this month’s issue of Primary Care Optometry News we take a look at the impressive anti-infective armamentarium at our disposal – and how to make the best use of each drug. For suspected gram-negative contact lens infections, ciprofloxacin and levofloxacin remain solid choices. For surgical prophylaxis and suspected gram-positive infections, moxifloxacin and gatifloxacin are exceptional first-line therapies. With the introduction of besifloxacin, we are more confident than ever in our ability to manage bacterial infections, including certain strains of methicillin-resistant Staphylococcus aureus.
Additionally, topical azithromycin provides us with another effective treatment for bacterial conjunctivitis as well chronic eyelid disease. Finally, with an impressive array of oral antivirals, we are well equipped for treating primary herpetic disease as well as prophylaxing against its recurrence.
While we enter this year’s cold season with more therapeutic options than ever, the recent H1N1 outbreak should serve as a stern reminder of the importance of prevention. There is no substitute for common sense and good hygiene in the battle against infectious disease. So, this cold season let us take every opportunity to educate patients on infection prophylaxis. My guess is that it will not only make this year a bit easier, but will pay dividends in the years to come as well.