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Treat infection aggressively, concisely
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![Michael D. DePaolis, OD, FAAO [photo]](/~/media/shared-images/michael-d-depaolis-od-faao.jpg)
It’s a scenario we’ve all experienced time and again. A patient is referred by his primary care physician after being appropriately diagnosed and treated for an ocular bacterial infection 1 week prior. Because he did not respond to first-line therapy, you prescribe a more contemporary antibiotic, and the infection clears nicely. Disaster averted.
Then there’s the more serious situation. You diagnose an incipient bacterial corneal ulcer and treat aggressively with the most contemporary antibiotic, but, unfortunately, the patient fails to respond. After a prolonged course of fortified antibiotics the infection clears. Disaster averted … barely.
Even today, concerns of bacterial resistance loom large over clinicians. And it’s not only in eye care. Just over a year ago, the Infectious Disease Society of America composed a report, “Bad bugs, no drugs: as antibiotic discovery stagnates – a public health crisis brews,” which underscored the magnitude of emerging bacterial resistance.
It is estimated that this year alone, nearly 2 million Americans will acquire bacterial infections during hospitalization and, sadly, 90,000 will die. More than 70% of the offending pathogens will be resistant to at least one of the antibiotics commonly used to treat them. What is even more unsettling is that some of these pathogens are now being implicated in infections outside of health care facilities. In eye care alone, an increasing number of methicillin-resistant Staphylococcus aureus and fluoroquinolone-resistant Pseudomonas aeruginosa have been reported.
Research not keeping pace
A bigger concern is that antibiotic drug research and development might not keep pace. Fewer than a dozen “new” antibiotics have been introduced over the past decade, and only a handful are currently under development. While pharmaceutical manufacturers continue to research hundreds of drugs, they tend to shy away from antibiotics for a variety of reasons, including: the long and costly process of bringing an antibiotic to market, short patent protection periods from generics, product liability issues and the fact that antibiotics are often used only for short periods. Certainly, pharmaceutical manufacturers enjoy a greater “annuity” from hypertensive, cholesterol lowering, anti-depressant or – for that matter – glaucoma medications.
From a clinician’s perspective, our mission should be clear. Treat bacterial infections aggressively and concisely. Prescribing a potent antibiotic at frequent dosing intervals for a short period of time is our best defense against bacterial resistance. We must always be mindful of the potential for an already-resistant strain. In particular, any infection non-responsive to a newer-generation fluoroquinolone mandates prompt treatment with fortified antibiotics.
Finally, we must support those pharmaceutical companies committed to research and development. While prescribing an older-generation, generic antibiotic may have a short-term financial savings, it will ultimately have a long-term detrimental impact on public health.