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Bacterial resistance is increasing in parallel to both systemic and topical antibiotics, including antibiotics for ocular infections such as bacterial conjunctivitis. Bacterial resistance to ophthalmic antibiotics has been well documented worldwide for more than a decade. More recent studies support the continued trend of rising rates of bacterial resistance to ocular infections from resistant bacteria. The mechanism of action of antibiotics for killing bacteria provides a key for combating bacterial resistance.21 Older fluoroquinolones such as ofloxacin and ciprofloxacin, while targeting both topoisomerase IV and DNA gyrase, preferentially target topoisomerase IV of gram-positive bacteria, while the newer fluoroquinolones moxifloxacin and gatifloxacin target both of those enzymes. It remains important to understand the causes of bacterial resistance to topical antibiotics for ocular infections in order to devise strategies to minimize the development of further resistance.
Full prescribing information is available to Healthcare Professionals on the link at the top of this page.
Indications: For the treatment of minor eye or eyelid infections, such as conjunctivitis and blepharitis.
However, bacterial resistance soon emerged, and today resistance continues to increase at an alarming rate. Therefore, for high-level resistance to develop to newer fluoroquinolones, bacteria will have to generate resistant mutations in both enzymes.

Levofloxacin-resistant invasive Streptococcus pneumoniae in the United States: evidence for clonal spread and the impact of conjugate pneumococcal vaccine.
Microbial keratitis pathogens and antibiotic susceptibilities: a 5-year review of cases at an urban county hospital in North Texas.
Endophthalmitis after open globe injury: microbiologic spectrum and susceptibilities of isolates. Streptococcus pneumoniae from ophthalmic infections: serotype distribution and penicillin susceptibility. Methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative staphylococci from conjunctivas of preoperative patients. Prevalence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) among ocular MRSA isolates. Clinical and bacterial characteristics of acute bacterial conjunctivitis in children in the antibiotic resistance era.
Multidrug-resistant strains in clinical trials of besifloxacin in the treatment of bacterial conjunctivitis. Fluoroquinolone resistance in ophthalmology and the potential role for newer ophthalmic fluoroquinolones.

Organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis and vancomycin-resistant S aureus and Enterococci, as well as the emergence of multidrug-resistant bacteria, have created a serious challenge to the treatment of infectious diseases. Fortunately, many of the adaptive changes in β-lactamases are exclusive to one type of target, allowing one antibiotic to be effective if another is destroyed by these enzymes. Multidrug resistance was also observed by the Ocular TRUST program, which evaluates the annual change of in vitro antimicrobial susceptibilities in national samples of ocular isolates.
The newer fluoroquinolones also achieve high tissue concentrations relative to their minimum inhibitory concentration (MIC) values, which are generally two- to three-fold lower than the MICs of older fluoroquinolones.21 Nevertheless, as indicated above, there have been reports of ocular pathogen resistance to the new fluoroquinolones gatifloxacin and moxifloxacin.
Distributed by: Cambridge Healthcare Supplies Ltd, Unit 1 Chestnut Drive, Wymondham, NR18 9SB. Today (TRUST), Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin (PROTEKT), the international SENTRY Antimicrobial Surveillance Program, and Active Bacterial Core have documented the increase in bacterial resistance.
For fluoroquinolone antibiotics, the major targets are DNA gyrase and topoisomerase IV, enzymes that primarily affect DNA replication.5 Mutation of one or both enzymes confers resistance by preventing the binding of a fluoroquinolone to the enzyme.

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27.08.2014, author: admin

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