Rethinking Ocular Antiinfectives

Four Part Series

Recent work has challenged conventional thinking about the meaning and determinants of antibiotic potency in the ocular situation. In addition, the presence of new topical antibiotic formulations with properties different from other drugs in the class, changes the options available to physicians. By being made aware of these findings, ophthalmologists will be better able to evaluate new medications and select optimal antibiotic agents, especially for surgical prophylaxis.

Rethinking Ocular Antiinfectives will analyze the various factors that determine the efficacy of ocular antibiotics. This discussion will include an overview of how ocular antiinfectives have evolved, and it will offer new thinking about drug penetration into ocular tissues as it relates to antibiotic efficacy. Novel antiinfectives will also be described, as will the impact of the growing prevalence of fluoroquinolone-resistant ocular flora. Ophthalmologists will be able to apply this information immediately as they seek out the best options for preventing and managing ocular infection.

Educational Design: Each installment of Rethinking Ocular Antiinfectives is divided into two parts; each of these parts treats some aspect of the theme in a specific way:

  • The “Pharmacology Perspective” is a major review that outlines the expert consensus on the topic area, bringing together the research findings of highly regarded clinical scientists.
  • The “Clinical Perspective” takes the information above and applies it to clinical practice from the perspectives of highly qualified ophthalmologists.
  • Rethinking Ocular Antiinfectives has been produced as an independent Continuing Medical Education enduring material since 2010, sponsored by Bausch + Lomb.

Faculty: Penny Asbell, MD, Marguerite B. McDonald, MD, John Sheppard, MD, MMSc, William B. Trattler, MD, MD, and Susanne Gardner, PharmD.


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Part 1 – The Growth of Antibiotic Resistance and Its Meaning for Drug Selection

Learning Objectives:

  • Discuss the change in prevalence of MRSA ocular infections over the last three decades.
  • Describe the relationship between methicillin resistance and fluoroquinolone resistance.
  • State the clinical impact of the rise of MRSA and fluoroquinolone-resistant ocular infections.

Practice Perspective: Penny A. Asbell, MD

Pharmacology Perspective: Susanne Gardner, PharmD


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Part 2 – Evolution of Fluoroquinolones: What Has Been Gained with Each New Molecule?

Learning Objectives:

  • List three factors that promote antibiotic resistance.

  • Describe the ways in which specific changes to molecular structure have increased the potency of succeeding generations of fluoroquinolones.

  • List three strategies for combating bacterial resistance.

Practice Perspective: Marguerite B. McDonald, MD

Pharmacology Perspective: Susanne Gardner, PharmD


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Part 3 – Rethinking the Importance of Intraocular Drug Penetration

Learning Objectives:

  • Discuss the implications of the modest intraocular drug levels achieved by topical administration of fluoroquinolones in an environment of rising concern over bacterial resistance.

  • List potential dangers of intracameral administration of prophylactic antibiotic.

  • List two factors that limit the amount of topical antibiotic that reaches the aqueous humor.

Practice Perspective: John Sheppard, MD, MMSc

Pharmacology Perspective: Susanne Gardner, PharmD


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Part 4 – Pharmacokinetics / Pharmacodynamics and Bacterial Killing: Selecting the Most Effective Agent

Learning Objectives:

  • List four pharmacokinetic parameters and state the measurements required to derive each.

  • Discuss at least one effect of drug formulation on antibiotic pharmacokinetics.

  • State two ways in which antibiotic resistance patterns have changed over the past 20 years.

Practice Perspective: William B. Trattler, MD

Pharmacology Perspective: Susanne Gardner, PharmD