Current use of antibiotics in opthalmology

The use of antibiotics in opthmalmology is based on the information from sensitivity studies derived from the ocular microbiology laboratory and results of clinical studies. Because of systemic use of antibiotics, bacteria develop mechanisms of resistance over time. The organisms considered pathogens evolve to become less frequent, and unusual organisms become the primary culprit. We have found an increasing trend of gram positive organisms such as Staphylococci and a decreasing incidence of gram negatives. As the same time, the antibiotic sensitivity profile has changed. The fluoroquinolones have been the antibiotic of choice for the last decade. Current laboratory data show a decreasing sensitivity profile. Clinical data are beginning to emerge that mirror this information. Data show that aminoglycosides, penicillins and other antibiotics such as vancomycin and chloramphenicol may be more appropriate. New antibiotics such as the oxazliodones and new generation quinolones may soon become the antibiotics of choice. (AU)

Considerations for implementing an antibiotic policy in hospital practice

An antibiotic policy should aim for the safe, effective and economical use of antimicrobial drugs, and to prevent their indiscriminate use and development of resistant bacterial strains. The term 'antibiotic' is used as a general term for all antimicrobial drugs. Antibiotics prescriptions should be based on clinical evidence of bacterial infection, preferably substantiated by appropriate laboratory culture and sensitivity tests. Viral infections are not an indication for antibiotic prescriptions. Patient factors to be considered for choice and dose of an antibiotic are age, pregnancy, lactation, renal and hepatic impairment. Immunodeficient patients should receive only bactericidal drugs. Severity of infection determines the route of administration. Duration of therapy should not exceed five days, unless specifically prescribed by the physician. An antibiotic should, if started as an empirical therapy not be changed before a minimum of three days trial. Prescriptions of drugs such as aztreonam, imipenem, vancomycin, piperacillin and amphotericin are to be restricted due to cost and toxicity and should be reviewed by the microbiologist (AU)