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One drop of antibiotic could cause resistance
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To the Editor:
The editorial by Primary Care Optometry News Editor Michael D. DePaolis, OD, FAAO, in the September 2013 issue (“ODs can help reduce antibiotic resistance,” page 3) was certainly timely and right on the money. What can make his advice most effective is to identify specific behaviors that we should avoid, and I would be happy to offer one.
I was trained many years ago, as I am sure most of us were, to administer a drop or two of an antibiotic to a patient after an anterior segment surgical procedure or after a minor anterior segment injury, even though the patient would not be given a prescription for a full course of antibiotic treatment. At the time, this was considered to be the standard of practice and proper prophylaxis.
Unfortunately, in retrospect, I trained many residents and students to follow the same practice and I continued that practice until about 8 years ago when I finally realized what I was doing. We should remember that leaving one live bacterium on the ocular surface after administration of an antibiotic may be enough for the development of an antibiotic resistant strain.
Prophylaxis today can be achieved with one drop of Betadine (povidone-iodine 1.25% to 10%, Alcon) applied to the ocular surface for 1 minute, then washed out, or a full course of an antibiotic, oral or topical, at the appropriate dose for 7 to 10 days. Povidone-iodine is far superior to a course of antibiotic drops in decreasing bacterial growth and resistance after intravitreal injections, according to Midier and colleagues, with no risk of the bacteria developing resistance.
Please continue to look for and publish behavior-specific practices we should avoid.
Mark R. Flora, OD
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Disclosure: Flora has no relevant financial disclosures.