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Next-generation fluoroquinolones: prescribe optimal dosing with authority
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It’s difficult to imagine a world without antibiotics. Yet that was life a mere 70 years ago. Ever since the introduction of sulfanilamide and penicillin the strides made in antibiotic therapy have been nothing short of phenomenal. We now have an arsenal of exquisitely engineered, clinically proven, highly targeted antibiotics with which to battle virtually any bacteria. Indeed, one need look no further than the countless lives – and eyes – that have been saved as a testimony of their efficacy.
Unfortunately, our foe is a formidable one. Bacteria are – as a rule – survivors. They are ubiquitous, opportunistic and resourceful little bugs. They often possess the uncanny ability to adapt in the face of an adverse environment and to even spontaneously mutate as a defense strategy. The result? An expanding pool of bacteria resistant to standard treatment protocols.
Better antibiotics
Fortunately, as clinicians we benefit from a strong consortium of pharmaceutical researchers committed to developing even better antibiotics. This trend will be particularly evident with the imminent release of our fourth-generation fluoroquinolones.
The next-generation fluoroquinolones – moxifloxacin and gatifloxacin – have indeed distinguished themselves in in-vitro laboratory testing as well as clinical trials. Their increased potency with respect to susceptible strains as well as their ability to eradicate resistant strains (especially gram-positive bacteria) is well documented.
What remains to be seen is exactly how these agents are integrated into mainstream clinical practice. Will they become our agents of choice in ophthalmic surgical perioperative prophylaxis? Will they be indicated in monotherapy for infectious keratitis? How quickly will they become our first-line therapies for conjunctivitis?
No one knows for sure when these next-generation fluoroquinolones will become available. What we do know is that they must be embraced and prescribed with the same dictums as with previous generation antibiotics.
Prescribe wisely
First and foremost, we must prescribe the optimal dosing frequency. Indeed, sub-lethal dosing frequencies really don’t benefit anyone. Second, we must prescribe with authority. Professional drug samples are meant to initiate the prescribing process rather than last for the duration of treatment. Finally, we must do what’s best for our patients. While we don’t want to indiscriminately prescribe our latest generation antibiotics, but we don’t want to sequester them either! Remember, it’s rarely ophthalmic applications that lead to bacterial resistance.
At Primary Care Optometry News we’ll do our best to provide our readers with the most clinically relevant information on these new-generation fluoroquinolone antibiotics. We think you – and your patients – will find them a welcome addition in the war against infection.