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ABSTRACT Bacterial conjunctivitis is a common ocular infection that, although usually self-limited, can result in severe cases and develop vision threatening complications.
As a double halogenated topical chlorofluoroquinolone, BESIVANCE® demonstrates potent activity against a range of important ocular pathogens, including strains of methicillin-resistant staphylococci, and susceptible isolates of Pseuedomonas aeruginosa.
BESIVANCE® is for topical ophthalmic use only, and should not be injected subconjunctivally, nor should it be introduced directly into the anterior chamber of the eye. As with other anti-infectives, prolonged use of BESIVANCE® may result in overgrowth of nonsusceptible organisms, including fungi. Patients should not wear contact lenses if they have signs or symptoms of bacterial conjunctivitis or during the course of therapy with BESIVANCE®.
The most common adverse event reported in 2% of patients treated with BESIVANCE® was conjunctival redness. The organisms that most often cause bacterial conjunctivitis include Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, and Staphylococcus epidermidis.4 Among these, S.
When confronted by a case of bacterial conjunctivitis, the gold standard for determining the causative pathogen is to culture the conjunctiva. To achieve quick and effective bacterial eradication with empirical therapy, it is critical to choose an agent with a wide spectrum of antimicrobial activity.
Current generation fluoroquinolones are the antimicrobial agents most often used to manage ocular infections, including bacterial conjunctivitis, in large part because they have a broad spectrum of activity and are generally well tolerated. In one recent study, treatment with besifloxacin brought about rapid microbial eradication in cases of bacterial conjunctivitis culture-positive for MRSA and methicillin-resistant S.
In my experience, BESIVANCE® is highly effective in treating bacterial conjunctivitis, which I see as a reflection of its potent activity against both susceptible and resistant bacterial strains (see Case Study box). Ron Melton, OD, FAAO, practices at Charlotte Eye Ear Nose and Throat Associates in Charlotte, NC. Conjunctivitis, or "pink eye," is inflammation or infection of the lining of the eye, called the conjunctiva. Most cases of pink eye will simply run their course, but a doctor should determine if you have a case of pink eye that needs treatment with prescription medicine. Although topical over-the-counter redness-reducing agents can be used, second-generation antihistamines are more effective. Sometimes bacterial conjunctivitis can cause complications in children, particularly eye infections. Diagnosis of bacterial conjunctivitis is generally clinical, and most cases can be managed with empirical antibiotic therapy. Formulated in a mucoadhesive vehicle, BESIVANCE® also has excellent ocular surface residence time, making it a superb choice for the treatment of bacterial conjunctivitis.
Quinolones administered systemically have been associated with hypersensitivity reactions, even following a single dose.
It can resolve spontaneously, but topical antibiotic therapy offers a number of benefits.3 Antibiotic treatment can shorten the course of the disease, enabling a faster return to school or work. Routine culture of every case of conjunctivitis is impractical in general practice settings, however; and patients with bacterial conjunctivitis diagnosed from signs and symptoms are typically treated empirically with topical ophthalmic antibiotics.

Despite overall effectiveness of the class, fluoroquinolone resistance is a growing problem, and there has been a concerning rise in the prevalence of MRSA-caused ocular infections.6 To meet the long-term threat of bacterial resistance, a continuous stream of novel agents will be necessary.
In empirical therapy - the typical treatment for bacterial conjunctivitis - it is important to use a potent, broad-spectrum agent.
He is an adjunct faculty member of the Indiana University School of Optometry in Bloomington, IN and the Salus University (Pennsylvania College of Optometry) in Philadelphia, PA. Estimate of the direct and indirect annual cost of bacterial conjunctivitis in the United States.
Monitoring antibiotic resistance in ocular microorganisms: results from the Antibiotic Resistance in Ocular Microorganisms (ARMOR) 2009 Surveillance Study.
Nonclinical pharmacodynamics, pharmacokinetics, and safety of BOL-303224-A, a novel fluoroquinolone antimicrobial agent for topical ophthalmic use.
Target specificity of the new fluoroquinolone besifloxacin in Streptococcus pneumoniae, Staphylococcus aureus, and Escherichia coli.
Phase III efficacy and safety study of besifloxacin ophthalmic suspension 0.6% in the treatment of bacterial conjunctivitis. Besifloxacin ophthalmic suspension 0.6% in the treatment of bacterial conjunctivitis patients with Pseudomonas aeruginosa infections. Submit your case studies, clinical pearls, practice management tips, editorial, or other manuscripts. It may be caused by one or several factors, including allergens, irritants, abrasions, bacteria, and viruses.
In rare situations, pink eye that is severe or left untreated can cause permanent vision loss or damage to the eye. Seasonal conjunctivitis is usually due to ragweed, pollen, or other allergens that are around at certain times of year. Inflammation of almost any part of the eye, including the lacrimal glands and eyelids, or faulty tear film can lead to red eye.
Other common causes of red eye include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis.A thorough patient history and eye examination may provide clues to the etiology of red eye (Figure 1). Viral conjunctivitis usually spreads through direct contact with contaminated fingers, medical instruments, swimming pool water, or personal items.
Use of a potent, broad spectrum topical antibiotic maximizes the chances of rapid, successful resolution. Patients should be advised to discontinue use immediately and contact their physician at the first sign of a rash or allergic reaction. Faster resolution also reduces the risk of transmission and the potential for a lingering moderate or severe bacterial conjunctivitis causing serious complications.
In the short term, clinicians can be advised to treat bacterial conjunctivitis empirically with currently available agents that have the potency necessary to neutralize even resistant organisms. Perennial conjunctivitis is due to contact with allergens that are around at all times of the year, such as mold spores, animal dander, dust mites, and feathers. If your symptoms are severe, you may need to see a doctor, who will most likely prescribe a prescription eye drop for short-term use, such as a steroid.

It often comes with an upper respiratory infection, and symptoms include red eyes, itchiness, and a watery or mucous discharge. The history should include questions about unilateral or bilateral eye involvement, duration of symptoms, type and amount of discharge, visual changes, severity of pain, photophobia, previous treatments, presence of allergies or systemic disease, and the use of contact lenses. Indeed, a recent post hoc analysis of four clinical studies showed that treatment with BESIVANCE® leads to fast microbial eradication and high rates of clinical resolution in patients with bacterial conjunctivitis caused by P. Viral conjunctivitis may require the attention of a doctor, and antibiotics may be necessary to prevent a bacterial infection. Other common causes include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis.
The eye examination should include the eyelids, lacrimal sac, pupil size and reaction to light, corneal involvement, and the pattern and location of hyperemia. The clinical presentation of viral conjunctivitis is usually mild with spontaneous remission after one to two weeks.3 Treatment is supportive and may include cold compresses, ocular decongestants, and artificial tears. Signs and symptoms of red eye include eye discharge, redness, pain, photophobia, itching, and visual changes.
Generally, viral and bacterial conjunctivitis are self-limiting conditions, and serious complications are rare.
Because there is no specific diagnostic test to differentiate viral from bacterial conjunctivitis, most cases are treated using broad-spectrum antibiotics. Patients need prompt ophthalmology referral for aggressive management.4,12 Acute bacterial conjunctivitis is the most common form of bacterial conjunctivitis in the primary care setting.
The cause of red eye can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Staphylococcus aureus infection often causes acute bacterial conjunctivitis in adults, whereas Streptococcus pneumoniae and Haemophilus influenzae infections are more common causes in children. Although chloramphenicol is the first-line treatment in other countries, it is no longer available in the United States.
Polymerase chain reaction testing of conjunctival scrapings is diagnostic, but is not usually needed.
Seasonal allergic conjunctivitis is the most common form of the condition, and symptoms are related to season-specific aeroallergens. Allergic conjunctivitis is primarily a clinical diagnosis.Avoiding exposure to allergens and using artificial tears are effective methods to alleviate symptoms.

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