Whether it is for conjunctivitis or for another infection, it happens to have to take the antibiotic also for the eyes and, in fact, the antibiotic-resistance in the ophthalmological field is a rapidly growing phenomenon, but which has been talked about for a short time . This is demonstrated by the data of a recent survey conducted on a group of ophthalmologists who in 60% of cases consider antibiotic resistance a relevant problem for ophthalmology. In Italy, resistance to antibiotics remains among the highest in Europe and is, in most cases, above the European average. In our country, 7 to 10 percent of patients each year undergo a multi-drug resistant bacterial infection with thousands of deaths.
Antibiotics in ophthalmology
The problem of antibiotic resistance has often been treated and discussed for other areas of medicine, but very little in relation to ocular pathologies despite the widespread use of antibiotics. “The three basic rules for treating an eye infection are: try to use the right antibiotic with the right dosage and for the right amount of time,” he explains Luca Rossetti, director of the Ophthalmology Clinic of the San Paolo Hospital in Milan. “The use for long periods of low dosages, which only serve to reduce the microbial load and increase the possibility of isolating resistant strains, not only does not cure the infection, but generates resistant bacterial colonies over time. When we have conjunctivitis that follow each other quickly it is logical to think of a relapse and in some cases it will be necessary to resort to a conjunctival swab to precisely define the microbial agent and set up a targeted therapy “.
Glaucoma, how to defeat the thief of sight
by Claudia Carucci
The investigation
The possibility of antibiotic resistance developing to treat conjunctivitis is therefore far from remote. Recently, a survey of 150 Italian ophthalmologists was conducted by DoT Tech for Théa Farma that revealed a recent photograph on antibiotic resistance in eye infections. 60% of the specialists involved defined antibiotic resistance as a relevant problem for ophthalmology, especially in the presence of conjunctivitis which turned out to be ocular surface infections with a higher incidence of bacterial resistance, followed by keratitis and blepharitis, both in the outpatient setting and in post-surgical prophylaxis. According to the survey data, 98% of clinicians, considering their clinical case history of the last 6 months of activity, reported antibiotic-resistance phenomena in a range of patients between 10% and 30%, i.e. about 50,000- 100,000 patients per year.
Covid, so it also affects the eyes
by Marta Musso
Scientific researches
Three important international studies have analyzed the phenomenon of antibiotic resistance in ophthalmology. “A recently published study carried out in patients treated at the Turin ophthalmic hospital between 1988 and 2017 showed an important and growing resistance trend towards different classes of antibiotics used in ophthalmology”, he explains Scipione Rossi, director of Uoc Ophthalmology, San Carlo di Nancy Hospital, Rome and director of Aiccer (Italian Association of Cataract and Refractive Surgery). Even an American conducted between 2009 and 2018 on almost 6,000 patients in 88 sites examined the problem, recording how the phenomenon is spread evenly throughout the national territory. “In addition, an editorial from the American Academy of Ophthalmology revealed that some patients who performed many intravitreal injections per year and who were therefore subjected to many antibiotic prophylaxis developed resistance to the products used,” concludes Rossi.
When you risk resistance
Ocular surface infections with a higher incidence of bacterial resistance are conjunctivitis. “They are treated with antibiotic-based eye drops but often the therapy is not followed in the correct way and can, consequently, generate resistance” continues Rossetti. “Today we begin to understand that resistance is something that concerns us closely. The phenomenon is tangible and growing especially on an outpatient basis and when the patient presents with a red eye it is necessary to prescribe the antibiotic indicated to avoid inducing resistance “, he says. Vincenzo Orfeo, Head of the Ophthalmology Unit of the Mediterranean Clinic of Naples and Secretary of the Italian Cataract and Refractive Surgery Association.
When you can do without the antibiotic
Therefore, even in ophthalmology it is necessary to ‘dose’ the use of these drugs. “The first thing – continues Orfeo – is to try to understand if we are dealing with a bacterial form, to be treated with a full-dose antibiotic, a viral form or an allergy that should not be treated with antibiotics. Then think about the most suitable path, using antibiotics which, as emerges from the literature, are not used at a systemic level but at a local level, more effective for the patient “. To find information on antibiotic resistance in ocular infections, the website www.occhioalleresistenze.it has just been online, created as a space to highlight and answer the problem.
.