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Clinicians embrace fourth-generation fluoroquinolones
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![Michael D. DePaolis, OD, FAAO [photo]](images/commonart/depaolis.jpg)
I’ve long felt that one of the most enjoyable — and challenging — aspects of optometry involves navigating the ever-changing environment in which we practice. Whether differentially diagnosing a complex patient, contemplating a managed care provider contract or integrating a new practice technology, change is inevitable — and challenging.
Consider, for instance, the emergence of fourth-generation fluoroquinolones just over a year ago. On one hand, clinicians anxiously anticipated the arrival of moxifloxacin and gatifloxacin, as they offer an expanded spectrum of activity, increased potency and improved safety for our patients. On the other hand, these agents have joined a well-established treatment category, one in which numerous options already exist and in which prescribing patterns have become etched in stone. So, clinicians have faced another dilemma: how to integrate this new class of anti-infectives into patient care.
Comparing prescribing habits
As providers, we want to address these issues efficiently and accurately. We need to know how the fourth-generation fluoroquinolones are being embraced by the prescribing community in general and how our prescribing profile compares with those of our colleagues.
To better understand this issue, Primary Care Optometry News recently polled colleagues through www.PCONSuperSite.com regarding their fourth-generation fluoroquinolone prescribing habits. Click here to see related article. This is what we found:
- 22% of respondents are prescribing these drugs for all forms of external bacterial infections, including: blepharitis, conjunctivitis, keratitis and corneal ulceration.
- 34% of respondents are prescribing fourth-generation fluoroquinolones for conjunctivitis, keratitis and corneal ulceration.
- 22% of respondents are prescribing them for keratitis and corneal ulceration.
- 22% of respondents reserve these drugs for treatment of corneal ulcers only.
Undoubtedly, fourth-generation fluoroquinolones have been well embraced for a variety of reasons.
Engineered against resistance
First, and foremost, they work exceptionally well, providing incredible potency, increased solubility and tissue retention and with a spectrum of activity that exceeds previous-generation ophthalmic antibiotics.
Second, they provide us with the best chance of mitigating against bacterial resistance, having been engineered to be “resistance” resistant.
Third, the fourth-generation fluoroquinolones are extremely patient friendly, combining less frequent dosing with a shorter treatment interval and, thereby, allowing patients to resume a normal routine more quickly.
Finally, the fourth-generation fluoroquinolones are competitively priced with their third-generation predecessors, making them a reasonable alternative on prescription formularies.
While tomorrow will most assuredly bring us other dilemmas, it’s nice to know where we stand with respect to prescribing fourth-generation fluoroquinolones. For now.