Therapeutics News

The increasing incidence of microbial resistance to fluoroquinolones and a search for improved gram-negative coverage is prompting clinical studies of new fluoroquinolones and combination treatments. Many practitioners today are looking beyond the most commonly used fluoroquinolones, ciprofloxacin and ofloxacin, to fight emerging resistance.

With nearly 20 prescription therapies for ocular allergy approved by the Food and Drug Administration (FDA), it is becoming more and more challenging for practitioners to choose appropriate medications for their patients. In the United States, approximately 20% of the population suffers from allergies, and about 50% of these patients will need treatment.

Practitioners can consult an abundance of studies when deciding which topical ophthalmic fluoroquinolone to use, but many wonder whether the choice is a clinically significant one.

While fluoroquinolones have surpassed aminoglycosides and antibiotics as many practitioners’ first choice for the treatment of ocular infections, concerns about reports of microbial resistance and a lack of adequate gram-negative and gram-positive coverage have prompted researchers to seek alternative treatments.

An August 1999 warning about corneal problems with topical ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) kicked off a chain reaction of statements, rebuttals and clarifications by physicians, manufacturers and the American Society of Cataract and Refractive Surgery (ASCRS), and within 90 days a multimillion-dollar-a-year drug was withdrawn from the market.

FORT WORTH, Texas — Alcon Laboratories Inc. and its affiliate Falcon Pharmaceuticals Ltd. recalled its diclofenac sodium ophthalmic solution 0.1%, a topical ophthalmic non steroidal anti-inflammatory drug (NSAID), in the wake of reports of corneal perforations in patients using it.

WILMINGTON, Del. — Povidone-iodine, which has long been used as a disinfectant to reduce bacterial colony counts, can be used for presumed adenovirus and many other external ocular infections, a study says. Although confirmatory culture results and further clinical studies are needed, povidone-iodine researcher Robert Abel Jr., MD, has had success with using a 5% and 10% solution off-label for the treatment of presumed adenoviral conjunctivitis.

When infants and children are examined in the optometric office, a number of considerations must be made before using diagnostic drugs and prescribing pharmaceutical agents. Because the blood volume of children is relatively small due to their low body weight, medications have a greater potential to cause systemic toxicity than when used in adults. In addition, the pathogens that commonly cause pediatric ocular infection differ from those most frequently responsible for adult disease. In this article, I’ll review these issues and offer suggestions on prescribing for children in a safe and effective manner.

Fluoroquinolones, the latest and possibly last generation of antibiotic agents, offer practitioners a tool in their armamentarium that covers a wide range of bacteria that can infect the eye. Some doctors worry that the broad spectrum of activity may lead to overuse when first-generation antibiotics can resolve most routine infections. This overuse could contribute to bacteria developing resistance to the antibiotics, which would limit their usefulness in the future.

While topical medications are often sufficient for treating various ocular infections, certain conditions warrant the use of systemic anti-infectives. Typically, the level of tissue that is infected will determine whether to prescribe a topical or oral medication.