Antibiotic and anti-inflammatory therapy for ocular diseases

Mario La Rosa

Dipartimento di Pediatria, UO di Broncopneumologia, Allergologia e Fibrosi Cistica, Università degli Studi di Catania

Antibiotic and anti-inflammatory therapy for ocular diseases
Introduction  Antibiotic therapy  Antibiotics for Specific Ophtalmic Conditions  Steroidal anti-inflammatory drugs  Non-steroidal anti-inflammatory drugs (NSAIDs)  Conclusions

Antibiotic and anti-inflammatory therapy for ocular diseases
Introduction  Antibiotic therapy  Antibiotics for Specific Ophtalmic Conditions  Steroidal anti-inflammatory drugs  Non-steroidal anti-inflammatory drugs (NSAIDs)  Conclusions

Ocular infections

Eyes are organs with a high probability of contracting infections because of their anatomical position. Natural ocular mechanisms of defence are not always able to control infectous lesions. It is really important, for exemple, to diagnose corneal infections, because if they are not appropriately treated they can evolve in corneal opacities, with a deep decrease of sight.

Ocular infections
Endophtalmithis need an urgent tratement in order to avoid the widespread of the infection in the closer tissues, that in serious cases can cause the loss of function of the ocular bulb

with some problems in its tratement. As a matter of fact therapy is based on the control of symptoms. without a definitely resolution of the disease.Ocular infections Allergic conjunctivities’ incidence is increasing and it affects a large amount of people. .

John P Witcher. With the introduction of antibiotics in the 1940s. West J Med 1994 . to echo a popular slogan: “We’ve come a long way”. Since that time. effective tratement of blinding ocular infections finally became a reality.Ophthalmic antibiotic therapy In the therapy of bacterial ocular diseases a large number of antibiotics acting locally alone or sistemically are being used.

Antibiotic and anti-inflammatory therapy for ocular diseases Introduction  Antibiotic therapy  Antibiotics for Specific Ophtalmic Conditions  Steroidal anti-inflammatory drugs  Non-steroidal anti-inflammatory drugs (NSAIDs)  Conclusions  .

Fucidic acid . Ophtal Physiol Opt 1998 .Aminoglicosides .Ophthalmic antibiotic therapy Antibiotics available for topical use in the eye are: .Chloramphenicol .Fluoroquinolones .Chlortetracyclines .Polymixin Vale Janet.

show a quantitative biochemical selectivity. the aminoglicosides and chlortetracycline.Ophthalmic antibiotic therapy Cloramphenicol. Ophtal Physiol Opt 1998 . fusidic acid. Vale Janet. In differing ways they interact with bacterial ribosomes and inhibit the syntesis of bacterial proteins.

Vale Janet. either by passive diffusion and by active transport. Ophtal Physiol Opt 1998 . and in part distributional. as sensitive bacteria are able to accumulate higher concentrations of the drug. which is in part biochemical. because of the differences between human and bacterial ribosomes.Ophthalmic antibiotic therapy Chlortetracycline shows a quantitative selectivity.

Vale Janet. As a matter of fact there is some evidence that these drugs cause a disruption of the cytoplasmatic membrane structure. gentamicin and neomycin exert a rapid bactericidal effect which cannot be explained only trough inhibition of protein synthesis. Ophtal Physiol Opt 1998 .Ophthalmic antibiotic therapy The aminoglycocides framycetin.

The activity of this enzyme is necessary to initiate DNA and RNA synthesis. Vale Janet.Ophthalmic antibiotic therapy The fluoroquinolones (ciprofloxacin. Ophtal Physiol Opt 1998 . ofloxacin) are bactericidal through the inhibition of nucleic acid synthesis as a result of their inhibition of the enzyme DNA gyrase.

Ophthalmic antibiotic therapy The cationic detergent properties of the polymyxins allows them to interact with the phospholipids of the cell membrane. These drugs are then able to enter the membrane and disrupt its structure Vale Janet. Ophtal Physiol Opt 1998 .

Vale Janet. Ophtal Physiol Opt 1998 .Ophthalmic antibiotic therapy The Penicillins. carbenicillin. such as ticarcillin. Selected compuonds. piperacillin are used by other routes for Pseudomonas infections. are not generally used topically because of widespread resistance and allergy problems. which are bactericidal and qualitatively selective through their action in disrupting synthesis of bacterial cell walls.

Antibiotic and anti-inflammatory therapy for ocular diseases Introduction  Antibiotic therapy  Antibiotics for Specific Ophtalmic Conditions  Steroidal anti-inflammatory drugs  Non-steroidal anti-inflammatory drugs (NSAIDs)  Conclusions  .

considering that this therapy should be altered if the corneal ulcers worsens and microbiological investigations prove that the responsable pathogen is resistant to the initial therapy.Antibiotics for Specific Ophtalmic Conditions Bacterial keratitis It is well known that the initial therapy for suspected bacterial keratitis should include broad-spectrum antibiotics.Clinical and Experimental Ophthalmology 2006 . Cameron N Ly MB BS.

Ophthalmic antibiotic therapy in bacterial keratitis With the increase of resistance among infective agents. Cameron N Ly MB BS. in order to optimaze the initial therapy for patients with suspected bacterial keratitis. it is important to know the antibiotic susceptibility of current ocular surface pathogens.Clinical and Experimental Ophthalmology 2006 .

Cameron N Ly MB BS.Clinical and Experimental Ophthalmology 2006 . performed a quantitative susceptibility testing to six antibiotics on all bacteria isolated from 112 patients who presented to the Sydney Eye hospital Emergency Department with presumed bacteria keratitis.Ophthalmic antibiotic therapy in bacterial keratitis Cameron N. and coll.

Ophthalmic antibiotic therapy in bacterial keratitis Bacterial species isolated from corneal scrapings taken from 112 patients with suspected bacterial keratitis. Cameron N Ly MB BS.Clinical and Experimental Ophthalmology 2006 .

Clinical and Experimental Ophthalmology 2006 .Ophthalmic antibiotic therapy in bacterial keratitis Antibiotics used in the study. The initial topical antibiotic treatement is shown in the black bar and the number of successful cases shown in the shaded bar. Cameron N Ly MB BS.

Ophthalmic antibiotic therapy in bacterial keratitis  The mentioned study showed that cephalosporins and aminoglycosides were complementary in their microbial cover.Clinical and Experimental Ophthalmology 2006 . The Cephalosporin plus aminoglycoside combination therapy has proven an effective initial broad-spectrum treatement of bacterial keratitis in many other studies in London. Sweden and the USA.  Cameron N Ly MB BS.

3% ciprofloxacin topical monotherapy and 0. Cameron N Ly MB BS.Clinical and Experimental Ophthalmology 2006 . as demonstrated in large prospective multicentre studies that supported the use of 0.3% ofloxacin topical monotherapy.Ophthalmic antibiotic therapy in bacterial keratitis The use of fluoroquinolones has been shown to be an effective alternative for the usual cephalosporine and aminoglycoside combination therapy.

Ophthalmic antibiotic therapy in bacterial keratitis Ciprofloxacin is also one of a few antibiotics that enters the human eye after oral administration.Clinical and Experimental Ophthalmology 2006 . Cameron N Ly MB BS.

0) Cameron N Ly MB BS.Ophthalmic antibiotic therapy in bacterial keratitis Distribution of ciprofloxacin minimum inhibitory concentration (MIC).Clinical and Experimental Ophthalmology 2006 . Fifty-one out of 53 isolates were likely to respond to ciprofloxacin (MIC </= 4.

red eyes with lid and conjunctival edema.Antibiotics for Specific Ophtalmic Conditions Conjunctivitis  Most cases of conjunctivitis have a viral etiology. with prominent symptoms being itchy. watery.  - Good choises include: Polytrim Tobramycin Richmond Eye Associates. Ophtalmology Update Jul 2001 . In this case eyedrop antibiotics are useful to prevent a secondary bacterial infection.

Antibiotics for Specific Ophtalmic Conditions Conjunctivitis .

Good antibiotic choises include: . Ophtalmology Update Jul 2001 .Gentamycin .Antibiotics for Specific Ophtalmic Conditions Conjunctivitis Bacterial conjunctivitis is characterized by a copious purulent discharge.Polytrim .Neosporin Richmond Eye Associates.Tobramycin .Ocuflox .

Antibiotics for Specific Ophtalmic Conditions Conjunctivitis Chlamydia Trachomatis is a cause of chronic conjunctivitis and appropriate systemic treatement is indicated along with Erythromycin ophthalmic ointment. Ophtalmology Update Jul 2001 . Richmond Eye Associates.

Polytrim Cipro. Quixin (if there are stronger risk factors for infection due to the nature of the injury) - - Erythromycin. Ocuflox. Tobramycin.Antibiotics for Specific Ophtalmic Conditions Prophylaxis of corneal abrasions Antibiotics eyedrops or ointments should be used during the healing period of corneal abrasions to prevent corneal ulcer. Good antibiotic choices include: Gentamicin. Bacitracin (for particularly large corneal abrasions) Richmond Eye Associates. Ophtalmology Update Jul 2001 .

antibiotic oinments applied at bedtime such as Erytromycin. Bacitracin or Tobramycin can be useful. Yet short courses fo steroid/antibiotic combination oinments such as Maxitrol. Ophtalmology Update Jul 2001 .Antibiotics for Specific Ophtalmic Conditions Blepharitis For significant flare-ups of the condition. Dexacidin and Tobradex may give more rapid relief. Richmond Eye Associates.

Antibiotics for Specific Ophtalmic Conditions Blepharitis .

Antibiotics for Specific Ophtalmic Conditions Endophthalmitis John P Witcher. West J Med 1994 .

Antibiotics for Specific Ophtalmic Conditions Endophthalmitis .

Antibiotics in ocular tuberculosis The most common manifestation of the ocular involvment in tuberculosis is uveitis. becoming more pigmented as the time passes. M.. panuveitis or as a choroiditis. which appear yellow. The Ocular Immunology and Uveitis Foundation 1999 .C. In the posterior ocular pole it is possible to find choroidal tubercles. C. usually presenting as a chronic anterior uveitis. Micheal Samson.

Antibiotics in ocular tuberculosis Fundus potographs and corresponding fluorescein angiogram of presumed choroidal tubercle. . Photos courtesy of Joseph Walsh .D. M. Chairman of Ophthalmology at the New York Eye and Ear Infirmary. The patient was strongly PPD reacting and was treated with anti-tuberculous medications..

M.D.. Photos courtesy of Joseph Walsh . . after six months of treatement with antituberculous medications. Chairman of Ophthalmology at the New York Eye and Ear Infirmary.Antibiotics in ocular tuberculosis Fundus photo and corresponding fluorescein angiogram of the same patient.

Antibiotic and anti-inflammatory therapy for ocular diseases Introduction  Antibiotic therapy  Antibiotics for Specific Ophtalmic Conditions  Steroidal anti-inflammatory drugs  Non-steroidal anti-inflammatory drugs (NSAIDs)  Conclusions  .

Ophthalmic anti-inflammatory therapy Anti-inflammatories drugs used in ophthalmology can be divided in two groups: Topic and injectable steroidal antiinflammatories  Non steroidal antiinflammatories  .

and they have been used for several years as treatement of inflammation and immunological ophthalmic diseases. Genevieuve N.Steroidal anti-inflammatory drugs These kind of drugs are lack of specificity. Clinical and Experimental Optometry 2006 .

above all lymphocytes T.Steroidal anti-inflammatory drugs: mechanisms of action Their antiinflammatory and immunosuppressive action can be related to the following actions: Inhibition of lymphocites proliferation. with a decrease of the cellmediated immunity Suppression of lymphokines action. of macrophage migration and of the production of some growth factors   .

Clinical and Experimental Optometry 2006 .Steroidal anti-inflammatory drugs: mechanisms of action    Inhibition of the degranulation of neutrophil granulocytes. Genevieuve N. Decrease of vascular permeability Decrease of Prostaglandines production as consequence of the suppression of arachidonic acid synthesis. mastcells and basophil granulocytes. macrophages.

Clinical and Experimental Optometry 2006 .Steroidal anti-inflammatory drugs Genevieuve N.

Steroidal anti-inflammatory drugs Prednisolone Studies shows that Prednisolone has the greatest antiinflammatory efficacy of all topical ophthalmic steroids. iritis. chemical/termal burns of the cornea.it is well suited for treating severe forms of ocular inflammation such as episcleritis. Prednisolone acetate 1% is the most effective of the topical ophthalmic steroids for the treatement of uveitis and corneal inflammations. June 2006 . Reveiw of optamometry.

Dexamethasone is less clinically effective than prednisolone and has a greater tendency to raise intraocular pressure. making it a drug of second choise. June 2006 .Steroidal anti-inflammatory drugs Dexamethasone In its approved concentration. Reveiw of optamometry.

Steroidal anti-inflammatory drugs Fluorometholones They possesses good to excellent antiinflammatory properties . Reveiw of optamometry. There are two formulations of fluorometholone. while having a diminished propensity to cause secondary IOP increase. the alchool and the acetate. June 2006 .

Its usefulness in chronic care lies in its reduced tendency to cause secondary IOP increase. June 2006 . requiring long-term (beypnd three to four week) therapy such as low-grade chronic iridocyclitis and some cases of ocular allergy.Steroidal anti-inflammatory drugs Fluorometholone alchool It is used very commonly to treat a host of mild to moderate ocular scurface inflammatory conditions. Reveiw of optamometry.

Steroidal anti-inflammatory drugs Fluorometholone acetate This is the more clinically active form of the more familiar FML. Reveiw of optamometry. The indications for this product are essentially the sae for the other corticosteroids. The acetate formulation confers to fluorometholone greater clinical efficacy. June 2006 .

but not as effcacious as 1% prednisolone acetate. Reveiw of optamometry. June 2006 .Steroidal anti-inflammatory drugs Rimexolone It is a potent. yet its decreased propensity to raise intraocular pressure is very similar to that of the fluorometholones. relatively safe preparation. and it is close to.

Antibiotic and anti-inflammatory therapy for ocular diseases Introduction  Antibiotic therapy  Antibiotics for Specific Ophtalmic Conditions  Steroidal anti-inflammatory drugs  Non-steroidal anti-inflammatory drugs (NSAIDs)  Conclusions  .

Non-steroidal anti-inflammatory drugs (NSAIDs) They are inhibitors of prostaglandines’ synthesis with an anti-inflammatoey and analgesic activity. Moreover they do not interact with the ocular hydrodynamic. . The advantage of using them than steroidal agents is related to the fact that they do not induce a decrease of immunosystem activity.

This may have serious consequances for some patients.g asthmatics. Inhibition of the synthetic pathway from arachidonic acid to the prostaglandines may result in increased production of leukotrienes which are also inflammatory. Clinical and Experimental Optometry 2006 . Genevieuve N.Ophthalmic non-steroidal antiinflammatory drugs Most current NSAIDs inhibit both forms of the cyclooxygenase (COX) enzyme. e. as the leukotrienes cause bronchoconstriction.

Ophthalm Physiol Opt 1998 . laser trabeculoplasty and PRK.Ophthalmic non-steroidal antiinflammatory drugs Currently they are used in intra.and/or postoperative situations to reduce miosis during surgery and inflammation following cataract surgery. They are also used in the prevention and treatment of cystoid macular oedema and for the treatment of allergic conjunctivitis. Vale J.

Inflammatory reactions due to traumas Cornela neovascularization due to the use of contact lenses and its following inflammation.Ophthalmic non-steroidal antiinflammatory drugs Other therapeutics indications of NSAIDs in ocular diseases are: Inflammations of the anterior segment of the eye. - - Vale J. scleritis. which do not recognize a viral o bacterial etiology. Ophthalm Physiol Opt 1998 . such as corneal and conjunctical edemas.

Ophthalmic non-steroidal antiinflammatory drugs The topic NSAIDs actually in commerce all over the Europe are: .Ketorolac trometamina .Indometacina .Suprofene Genevieuve N. Clinical and Experimental Optometry 2006 .Piroxicam .Diclofenac sodico .Flubiprofene sodico .

Antibiotic and anti-inflammatory therapy for ocular diseases Introduction  Antibiotic therapy  Antibiotics for Specific Ophtalmic Conditions  Steroidal anti-inflammatory drugs  Non-steroidal anti-inflammatory drugs (NSAIDs)  Conclusions  .

.Conclusions •Infections of the eye can rapidly damage important functional structures and lead to permanent vision loss or blindness. •Broad-spectrum antibiotics should be administered to the appropriate site of infection as soon as a diagnosis is made. •Parenteral antibiotics are recommended for infection in deep adnexal structures. •Intravitreal antibiotics. •Topical drops are preferred for corneal and conjunctival infections. and possibly subconjunctival and parenteral antibiotics. are preferred for endophthalmitis.

treatment must be individualized and regular monitoring performed. . many patients will benefit from them either with better control of the ocular inflammation or with a decrease in corticosteroid side effects. With careful use of immunosuppressive drugs for treatment of ocular inflammatory disorders.Conclusions Is important to make a clinical diagnosis before treatment and of following the clinical course of patients carefully during treatment Because of the potential for side effects.

Grazie www.mariolarosa.it .

Sign up to vote on this title
UsefulNot useful