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Tsigara AS, Banti CN, Hatzidimitriou A, Hadjikakou SK. Tetracycline: structural characterization and antimicrobial properties of its water-soluble di-anionic bi-sodium salt. Dalton Trans 2024; 53:12080-12089. [PMID: 38869456 DOI: 10.1039/d4dt01384k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
The new water-soluble di-anionic bi-sodium salt of tetracycline (TC), an antibiotic in clinical use, with the formula {[TC]2-[Na+(MeOH)(H2O)] [Na+]·(H2O)}n (TCNa) was synthesized. The compound was characterized by m.p., attenuated total reflectance-Fourier transform infra-red (ATR-FTIR) spectroscopy, and ultraviolet (UV) and proton nuclear magnetic resonance (1H NMR) spectroscopy in the solid state and in solution. The molecular weight (MW) was determined by cryoscopy. The crystal structure of TCNa was also determined by X-ray crystallography. The antibacterial activity of TCNa was evaluated against the bacterial species Pseudomonas aeruginosa (P. aeruginosa), Escherichia coli (E. coli), Staphylococcus epidermidis (S. epidermidis) and Staphylococcus aureus (S. aureus) by means of minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and inhibition zones (IZs). Moreover, the ability of the compound to eradicate biofilm formation was also evaluated. The results are compared with those obtained for the commercially available drug TCH2. The in vitro and in vivo toxicities of TCNa were tested against human corneal epithelial cells (HCECs) and Artemia salina.
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Affiliation(s)
- Afroditi S Tsigara
- Biological Inorganic Chemistry Laboratory, Department of Chemistry, University of Ioannina, 45110 Ioannina, Greece.
| | - Christina N Banti
- Biological Inorganic Chemistry Laboratory, Department of Chemistry, University of Ioannina, 45110 Ioannina, Greece.
| | - Antonios Hatzidimitriou
- Laboratory of Inorganic Chemistry, Department of Chemistry, Aristotle University of Thessaloniki, Greece
| | - Sotiris K Hadjikakou
- Biological Inorganic Chemistry Laboratory, Department of Chemistry, University of Ioannina, 45110 Ioannina, Greece.
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2
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Franco S, Hammerschlag MR. Can we use azithromycin eye drops for gonococcal ophthalmia prophylaxis in the United States? Expert Rev Anti Infect Ther 2024; 22:373-377. [PMID: 38781483 DOI: 10.1080/14787210.2024.2359725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/21/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Neonatal ocular prophylaxis with 0.5% erythromycin ophthalmic ointment is mandated by law in many U.S. states despite its lack of efficacy in preventing chlamydial ophthalmia and the low incidence of gonococcal ophthalmia today. The current shortage of 0.5% erythromycin ophthalmic ointment is bringing into question what alternatives exist for neonatal ocular prophylaxis for the prevention of gonococcal ophthalmia. Providers in states with mandates are concerned with the implications of administering intramuscular ceftriaxone to every newborn. Azithromycin eye drops are being considered as an alternative. AREAS COVERED This article discusses 1% azithromycin eye drops as an alternative to 0.5% erythromycin ophthalmic ointment. Clinical experience, side effects, resistance, logistics, pharmacokinetics, and pharmacodynamics are considered. EXPERT OPINION Azithromycin eye drops are not an appropriate alternative to 0.5% erythromycin ophthalmic ointment for ocular prophylaxis. Prenatal screening and treatment of pregnant women is the most effective way to prevent neonatal ophthalmia. Mandates for universal prophylaxis should be withdrawn to avoid unnecessary medication administration, healthcare costs, and potential harm.
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Affiliation(s)
- Susannah Franco
- Departments of Pharmacy and Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Margaret R Hammerschlag
- Departments of Pharmacy and Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
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Garcia O’Farrill N, Abi Karam M, Villegas VM, Flynn HW, Grzybowski A, Schwartz SG. New Approaches to Overcoming Antimicrobial Resistance in Endophthalmitis. Pharmaceuticals (Basel) 2024; 17:321. [PMID: 38543107 PMCID: PMC10974156 DOI: 10.3390/ph17030321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 04/01/2024] Open
Abstract
Endophthalmitis is a rare but vision-threatening infection characterized by marked inflammation of intraocular fluids and tissues, uncommonly seen following surgery and intravitreal injection. Antimicrobials are used worldwide in the prophylaxis and treatment of bacterial and fungal infections of the eye and are standard treatment in the preoperative and postoperative care of surgical patients. However, antimicrobials are reported to be overprescribed in many parts of the world, which contributes to antimicrobial resistance (AMR). AMR complicates the prophylaxis and treatment of endophthalmitis. This article examines the prevalence and mechanisms of AMR in ocular microorganisms, emphasizing the importance of understanding AMR patterns for tailored treatments. It also explores prophylaxis and management strategies for endophthalmitis, with a discussion on the use of intracameral antibiotic administration. The use of prophylactic intracameral antibiotics during cataract surgery is common in many parts of the world but is still controversial in some locations, especially in the US. Finally, it highlights the role of stewardship in ophthalmology and its benefits in the treatment of endophthalmitis.
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Affiliation(s)
- Noraliz Garcia O’Farrill
- Department of Ophthalmology, University of Puerto Rico School of Medicine, San Juan, PR 00936, USA; (N.G.O.); (V.M.V.)
| | - Mariana Abi Karam
- Department of Ophthalmology, MetroHealth, Cleveland, OH 44109, USA;
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Victor M. Villegas
- Department of Ophthalmology, University of Puerto Rico School of Medicine, San Juan, PR 00936, USA; (N.G.O.); (V.M.V.)
| | - Harry W. Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 61-553 Poznan, Poland;
| | - Stephen G. Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Di Salvo M, Santi Laurini G, Motola D, Valpiani G, Sapigni E, Pompilio A, Arzenton E, Marra A. PAttern of drug use in PEdiatrics: An observational study in Italian hOSpitals (the PAPEOS study). Br J Clin Pharmacol 2024. [PMID: 38163762 DOI: 10.1111/bcp.15995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024] Open
Abstract
AIMS To assess the extent of off-label drug use and the occurrence of suspected adverse drug reactions (ADRs) among paediatric patients in Italian hospitals. METHODS We conducted a 2-year prospective cohort study across 22 Italian hospital wards from September 2020 to September 2022. As part of the surveillance project, we performed a 6-month retrieval of all reported ADRs and evaluated all drug prescriptions for their possible off-label use. Following an educational project on pharmacovigilance addressed to healthcare professionals in participating wards, the same data collection was performed. RESULTS Among the 892 patients included in the study, 64% were admitted to paediatric wards and 36% to neonatal wards. Fifty per cent of all drugs prescribed were used off-label and mainly concerned the administration of a different dose from the one authorized. In neonatal wards, off-label prescriptions occurred slightly more often, with antibacterials being the most frequently used off-label drugs. A total of 35 reports of suspected ADRs were collected, five before the educational project and 30 afterwards. Based on product licence, 10 of the total 35 reports concerned at least one off-label drug use. CONCLUSIONS The off-label use of drugs in treating paediatric patients was extensive in Italian hospitals. Regulatory interventions are needed to promote the use of drugs based on the latest available literature and improve ADR reporting on children. Paediatric indications and dosages of the drugs most commonly used in children should be supported by appropriate ad hoc studies.
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Affiliation(s)
- Marta Di Salvo
- Hospital Pharmacy, Azienda Ospedaliero-Universitaria di Ferrara Arcispedale S. Anna, Cona, Ferrara, Italy
| | - Greta Santi Laurini
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Domenico Motola
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giorgia Valpiani
- Research Innovation Office, S. Anna University Hospital of Ferrara, Cona, Ferrara, Italy
| | - Ester Sapigni
- Hospital Care Sector - Regional Center of Pharmacovigilance - Directorate General for Personal Care, Emilia Romagna Region Health Authority, Bologna, Italy
| | - Adriana Pompilio
- Hospital Pharmacy, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Elena Arzenton
- Department of Diagnostic and Public Health, Section of Pharmacology, University of Verona, Verona, Italy
| | - Anna Marra
- Hospital Pharmacy, Azienda Ospedaliero-Universitaria di Ferrara Arcispedale S. Anna, Cona, Ferrara, Italy
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Franco S, Hammerschlag MR. Neonatal ocular prophylaxis in the United States: is it still necessary? Expert Rev Anti Infect Ther 2023; 21:503-511. [PMID: 36691840 DOI: 10.1080/14787210.2023.2172401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Much has changed since Credé reported that silver nitrate decreases the incidence of ophthalmia neonatorum. Prenatal screening and treatment of pregnant women for Neisseria gonorrhoeae became standard in the 1950s and for Chlamydia trachomatis in 1993. Neonatal gonococcal and chlamydial conjunctivitis are consequently uncommon today. Currently, only 0.5% erythromycin ophthalmic ointment is available in the United States (U.S.) for neonatal ocular prophylaxis, which is ineffective against C. trachomatis. AREAS COVERED This article addresses the altered epidemiology of ophthalmia neonatorum in the U.S. since prophylactic practices began, the lack of data supporting ophthalmic erythromycin for prevention of neonatal gonococcal and chlamydial conjunctivitis, and the impact of prenatal screening and treatment of pregnant women for N. gonorrhoeae and C. trachomatis on conjunctivitis incidence. The authors discuss why erythromycin ophthalmic ointment is likely ineffective against gonococcal ophthalmia, including the development of macrolide resistance. Physiologic limitations and pharmacokinetic properties are considered with respect to ophthalmic erythromycin for the prevention of gonococcal and chlamydial conjunctivitis. EXPERT OPINION Administration of erythromycin ophthalmic ointment for the prevention of neonatal conjunctivitis is not literature-supported. Prenatal screening and treatment of pregnant women is the most effective way to prevent ophthalmia neonatorum. National mandates for prophylaxis should be withdrawn.
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Affiliation(s)
- Susannah Franco
- Department of Pharmacy, SUNY Downstate Medical Center, Pharmacy, Brooklyn, NY, USA
| | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Gupta K, Unhale R, Garner OB, Deng SX, M Fung SS. Infectious Keratitis Isolates and Susceptibility in Southern California. Cornea 2022; 41:1094-1102. [PMID: 35315617 DOI: 10.1097/ico.0000000000002884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 08/08/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to determine longitudinal trends in prevalence and resistance profiles for infectious keratitis at referral centers in Southern California. METHODS Cultured infectious keratitis cases from January 1, 2006, through December 31, 2009, and January 1, 2016, through December 31, 2019, at the University of California, Los Angeles, were evaluated. Outcome measures included microbial isolate prevalence and antibiotic/antifungal susceptibility and resistance patterns. RESULTS One hundred thirty-nine and 315 culture-positive isolates were obtained between 2006-2009 and 2016-2019, respectively. Gram-positive organisms accounted for 65% (2006-2009) and 74% (2016-2019) of bacterial isolates ( P = 0.076). Staphylococcus infections, the most common gram-positive and bacterial isolate in both study epochs, demonstrated increased prevalence from 2006-2009 to 2016-2019 (41% vs. 53%, P = 0.019). Although coagulase-negative Staphylococcus (CoNS) increased from 40% to 58% ( P = 0.0012), the prevalence of methicillin-resistant Staphylococcus aureus was unchanged (28% vs. 28%, P = 0.99). Pseudomonas aeruginosa , the most common gram-negative organism, demonstrated decreased prevalence from 18% to 10% ( P = 0.027). Candida species comprised 3.5% of culture-positive isolates in both epochs. All gram-positive isolates were susceptible to vancomycin, and all Staphylococcus isolates were susceptible to linezolid. Pseudomonas aeruginosa remained susceptible to tested fluoroquinolones (>93%) and aminoglycosides (100%) over time. CONCLUSIONS In southern California between 2006 and 2019, there was a shift toward Staphylococcus species, with increased CoNS, decreased methicillin-sensitive Staphylococcus aureus , and decreased prevalence of P. aeruginosa . Empiric therapy of vancomycin and a fluoroquinolone or aminoglycoside provides effective antibacterial coverage for predominant bacterial species when culture sensitivities are pending.
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Affiliation(s)
- Kishan Gupta
- Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA
- Department of Ophthalmology, Kaiser Permanente Medical Center, Downey, CA
| | - Rutuja Unhale
- Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA
| | - Omai B Garner
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA; and
| | - Sophie X Deng
- Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA
- Molecular Biology Institute, University of California, Los Angeles, CA
| | - Simon S M Fung
- Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA
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Mastropasqua L, Nubile M, Acerra G, Detta N, Pelusi L, Lanzini M, Mattioli S, Santalucia M, Pietrangelo L, Allegretti M, Dua HS, Mehta JS, Pandolfi A, Mandatori D. Bioengineered Human Stromal Lenticule for Recombinant Human Nerve Growth Factor Release: A Potential Biocompatible Ocular Drug Delivery System. Front Bioeng Biotechnol 2022; 10:887414. [PMID: 35813999 PMCID: PMC9260024 DOI: 10.3389/fbioe.2022.887414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/08/2022] [Indexed: 12/12/2022] Open
Abstract
Small incision lenticule extraction (SMILE), is a surgical procedure for the myopia correction, during which a corneal stromal lenticule is extracted. Given that we have previously demonstrated how this discarded tissue could be repurposed as a bio-scaffold for stromal engineering, this study aimed to explore its use as an ocular drug delivery system of active molecules, using neurotrophic factor Nerve Growth Factor (NGF). We employed human stromal lenticules directly collected from healthy donors undergoing SMILE. Following a sodium dodecylsulfate (SDS) treatment, decellularized lenticules were incubated with a suspension of polylactic-co-glycolic-acid (PLGA) microparticles (MPs) loaded with recombinant human NGF (rhNGF-MPs). Fluorescent MPs (Fluo-MPs) were used as control. Data demonstrated the feasibility to engineer decellularized lenticules with PLGA-MPs which remain incorporated both on the lenticules surface and in its stromal. Following their production, the in vitro release kinetic showed a sustained release for up to 1 month of rhNGF from MPs loaded to the lenticule. Interestingly, rhNGF was rapidly released in the first 24 h, but it was sustained up to the end of the experiment (1 month), with preservation of rhNGF activity (around 80%). Our results indicated that decellularized human stromal lenticules could represent a biocompatible, non-immunogenic natural scaffold potential useful for ocular drug delivery. Therefore, combining the advantages of tissue engineering and pharmaceutical approaches, this in vitro proof-of-concept study suggests the feasibility to use this scaffold to allow target release of rhNGF in vivo or other pharmaceutically active molecules that have potential to treat ocular diseases.
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Affiliation(s)
- Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Science, “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Mario Nubile
- Ophthalmology Clinic, Department of Medicine and Aging Science, “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | | | - Nicola Detta
- Dompé Farmaceutici SpA, Via Tommaso de Amicis, Naples, Italy
| | - Letizia Pelusi
- Department of Medical, Oral and Biotechnological Sciences, Center for Advanced Studies and Technology (CAST), StemTeCh Group, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Manuela Lanzini
- Ophthalmology Clinic, Department of Medicine and Aging Science, “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Simone Mattioli
- Dompé Farmaceutici SpA, Via Tommaso de Amicis, Naples, Italy
| | - Manuela Santalucia
- Department of Medical, Oral and Biotechnological Sciences, Center for Advanced Studies and Technology (CAST), StemTeCh Group, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Laura Pietrangelo
- Department of Medicine and Aging Sciences, Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | | | - Harminder S. Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jodhbir S. Mehta
- Tissue Engineering and Cell Group, Singapore Eye Research Institute, Corneal and External Department, Singapore National Eye Centre, Singapore, Singapore
| | - Assunta Pandolfi
- Department of Medical, Oral and Biotechnological Sciences, Center for Advanced Studies and Technology (CAST), StemTeCh Group, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Domitilla Mandatori
- Department of Medical, Oral and Biotechnological Sciences, Center for Advanced Studies and Technology (CAST), StemTeCh Group, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
- *Correspondence: Domitilla Mandatori,
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Rameshkumar G, Dhandapani R, Lalitha P, Rajapandian SGK, Palanivel V, Thangavelu S, Alyousef AA, Albalawi T, Alam P, Zubair M, Saleh FM, Alatawi FA, Husain FM. Prevalence and Molecular Characterization of Metallo β-Lactamase Producing Gram-Negative Pathogens Causing Eye Infections. Front Public Health 2022; 10:870354. [PMID: 35774580 PMCID: PMC9237426 DOI: 10.3389/fpubh.2022.870354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose:Metallo β-lactamases (MβL) production is a worldwide problem, particularly in gram-negative bacteria. As scanty data is available on the prevalence of MBL, the present study is being undertaken to determine the prevalence, antibacterial sensitivity patterns, and molecular characterization of MβL associated resistant genes in gram-negative bacteria isolated from ocular infections.Material and MethodsAt a tertiary eye care center in south India, 359 gram-negative pathogens, 200 isolates from eye infections, and 159 isolates from normal flora of the eye were studied. A gold standard microbiology method was used to identify the isolates. An antibiotic double disc synergy test and a combination disc test were used to detect MβL production. Multiplex PCR was used to investigate the molecular characteristics of the MβL encoding genes blaVIM, blaIMP, and blaNDM.ResultsOf the 359 gram-negative bacterial pathogens, Pseudomonas aeruginosa 108 (30.1%) and Enterobacter agglomerans 46 (12.8%) were commonly isolated. High prevalence of P. aeruginosa 81% (17 strains) was detected as an MβL producer and it shows 100% resistance to 2nd and 3rd generation cephalosporins and meropenem. Multiplex PCR detected only the blaVIM gene in 56 (28%) of various eye infections and 27 (17%) of normal flora of the gram-negative bacteria (GNB). The blaVIM gene is detected predominantly in 51.8% of keratitis and 21.4% of postoperative endophthalmitis. High prevalence of the gene was detected in P. aeruginosa 42.9% (24 of 56) and Alcaligens denitrificans 10.7% (6 of 56) from eye infections. Whereas, in the control group, P. aeruginosa and E. coli each had 14.8% (4 of 27) that were shown positive.ConclusionThe emerging MβLs mediated resistance among P. aeruginosa is a challenging task for ophthalmologists, especially in patients with endophthalmitis and bacterial keratitis. This local knowledge will aid in advising appropriate antibiotic use and avoiding unnecessary antibiotic prescriptions, which are highly warranted.
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Affiliation(s)
- Gunasekaran Rameshkumar
- Medical Microbiology Laboratory, Department of Microbiology, Alagappa University, Karaikudi, India
- Department of Ocular Microbiology, Aravind Eye Hospital, Madurai, India
| | - Ranjithkumar Dhandapani
- Medical Microbiology Laboratory, Department of Microbiology, Alagappa University, Karaikudi, India
| | - Prajna Lalitha
- Department of Ocular Microbiology, Aravind Eye Hospital, Madurai, India
| | | | - Velmurugan Palanivel
- Centre for Material Engineering and Regenerative Medicine Bharath Institute of Higher Education, Chennai, India
| | - Sathiamoorthi Thangavelu
- Medical Microbiology Laboratory, Department of Microbiology, Alagappa University, Karaikudi, India
| | - Abdullah A. Alyousef
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Thamer Albalawi
- Department of Biology, College of Sciences and Humanities, Prince Sattam Bin Andulaziz University, Alkharj, Saudi Arabia
| | - Pravej Alam
- Department of Biology, College of Sciences and Humanities, Prince Sattam Bin Andulaziz University, Alkharj, Saudi Arabia
| | - Mohammad Zubair
- Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
- *Correspondence: Mohammad Zubair
| | - Fayez M. Saleh
- Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
| | | | - Fohad M. Husain
- Department of Food Science and Nutrition, King Saud University, Riyadh, Saudi Arabia
- Fohad M. Husain
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Grandi G, Cavallo R, Zanotto E, Cipriani R, Panico C, Protti R, Scapagnini G, Davinelli S, Costagliola C. In vitro antimicrobial activity of ozonated oil in liposome eyedrop against multidrug-resistant bacteria. Open Med (Wars) 2022; 17:1057-1063. [PMID: 35795001 PMCID: PMC9175013 DOI: 10.1515/med-2022-0495] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022] Open
Abstract
Bacteria are the most common causative agents of ocular infections. Treatment with topical broad-spectrum antibiotics is recommended in severe cases. However, antibiotic resistance has become a major concern in recent years, although antibiotics are generally effective in treating ocular infections. Antibacterial compound screening is performed to identify alternative therapeutic options to antibiotics. The aim of this study was to assess the in vitro antimicrobial activity of an ophthalmic solution containing ozonated oil. Strains of bacterial species with a multidrug resistance profile, which are responsible for a large proportion of ocular infections, were isolated and selected from different biological samples. The bacterial isolates were cultured, and ozonated oil was used to evaluate the inhibition zones at different time points. The treatment exhibited antibacterial activity against all the tested species. The effect was lower against the strains of Pseudomonas aeruginosa and more evident against Staphylococcus and Streptococcus spp. Our results suggest that the administration of ozonated oil may be a candidate agent to treat some infections of the ocular surface with a potential role in antimicrobial prophylaxis.
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Affiliation(s)
- Giuseppe Grandi
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, 10126, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, 10126, Italy
| | - Elisa Zanotto
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, 10126, Italy
| | - Raffaella Cipriani
- Microbiology and Virology Unit, Amedeo di Savoia Hospital, Turin, 10149, Italy
| | - Claudio Panico
- Ophthalmology Unit, Humanitas Gradenigo Hospital, Turin, 10153, Italy
| | - Romolo Protti
- Ophthalmic Unit, Hospital San Biagio, Domodossola, 28845, Italy
| | - Giovanni Scapagnini
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Via V. De Sanctis, s.n.c., Campobasso 86100, Italy
| | - Sergio Davinelli
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Via V. De Sanctis, s.n.c., Campobasso 86100, Italy
| | - Ciro Costagliola
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Via V. De Sanctis, s.n.c., Campobasso 86100, Italy
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Biswas P, Batra S, Gurha N, Maksane N. Emerging antimicrobial resistance and need for antimicrobial stewardship for ocular infections in India: A narrative review. Indian J Ophthalmol 2022; 70:1513-1521. [PMID: 35502016 PMCID: PMC9333024 DOI: 10.4103/ijo.ijo_2537_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/09/2021] [Accepted: 01/30/2022] [Indexed: 11/05/2022] Open
Abstract
Patients with ocular infections are at increased risk of vision impairment and may require immediate medical care to preserve their vision. Management of ocular bacterial infections has evolved in recent years and includes a pragmatic selection of broad-spectrum antibiotics based on the causative bacteria. Nevertheless, the treatment of bacterial ocular infections is increasingly becoming a challenge, as the causative bacterium acquires resistance to antibiotics through intrinsic and acquired methods. From an Indian perspective, along with the challenges of antibiotic resistance, there are other factors such as lack of knowledge on epidemiology, and lack of data on local susceptibility patterns of ocular pathogens that have significant impact on the management of ocular infections. This narrative review summarizes the available knowledge on prescribing antibiotics for five common ocular infections in India. It further highlights the significance of the understanding of antimicrobial susceptibility patterns across India as a cornerstone to promote rational use of ocular antibiotics. This review indicates that large-scale antimicrobial resistance surveillance studies can facilitate the synchronization of ophthalmic antimicrobial prescription policies with local antibiotic resistance patterns. Further, establishment of an antimicrobial stewardship program in ophthalmology can potentially increase the efficacy of diagnostic tools, and implement earlier adoption of effective antibiotics. Overall, this review provides consolidated information and key considerations for treatment decision-making of common ocular infections in India.
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Affiliation(s)
- Partha Biswas
- Department of Ophthalmology, B B Eye Foundation, Kolkata, West Bengal, India
| | - Sneha Batra
- Department of Ophthalmology, B B Eye Foundation, Kolkata, West Bengal, India
- Department of Ophthalmology, Trenetralaya Eye Care and Surgical Centre, Bengaluru, Karnataka, India
| | - Neha Gurha
- Department of Medical Affairs, Novartis Healthcare Private Limited, Mumbai, Maharashtra, India
| | - Nitin Maksane
- Department of Medical Affairs, Novartis Healthcare Private Limited, Mumbai, Maharashtra, India
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Nakanishi T, Inose R, Kusama Y, Ishikane M, Kajihara T, Yahara K, Sugai M, Ohge H, Ohmagari N, Muraki Y. The use of topical antibiotics based on National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data in 2017. Jpn J Infect Dis 2021; 75:177-182. [PMID: 34588368 DOI: 10.7883/yoken.jjid.2021.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The national action plan on antimicrobial resistance (AMR) in Japan emphasizes the importance of understanding antimicrobial use (AMU). Some studies have been conducted on oral and parenteral AMU in Japan. However, there are few studies on the use of topical antimicrobials, such as in dermatology and ophthalmology. Therefore, the purpose of this study was to investigate topical AMU in Japan. Data on AMU in dermatology and ophthalmology were obtained from the 2017 National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data. The number of dermatological products used was 58,396,530 in 2017. The proportion of betamethasone/gentamicin was 50.5% and that of gentamicin 16.7%, whereas that of the ingredient quantity in gentamicin was 7.8%. It was suggested that topical AMU should be evaluated by the number of products. The number of ophthalmological products used was 24,655,653 in 2017, and the proportion of quinolones was 95.9%. The high prescription rate of quinolones may cause an increase in quinolone resistance in the ophthalmologic field. Topical AMU, which is a potential "blind spot" in the measures against AMR, needs to be continuously monitored, together with systemic AMU.
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Affiliation(s)
- Tomoko Nakanishi
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Japan
| | - Ryo Inose
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Japan
| | - Yoshiki Kusama
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Masahiro Ishikane
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Toshiki Kajihara
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Japan
| | - Koji Yahara
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Japan
| | - Motoyuki Sugai
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Yuichi Muraki
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Japan
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Jadi PK, Sharma P, Bhogapurapu B, Roy S. Alternative Therapeutic Interventions: Antimicrobial Peptides and Small Molecules to Treat Microbial Keratitis. Front Chem 2021; 9:694998. [PMID: 34458234 PMCID: PMC8386189 DOI: 10.3389/fchem.2021.694998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/02/2021] [Indexed: 01/10/2023] Open
Abstract
Microbial keratitis is a leading cause of blindness worldwide and results in unilateral vision loss in an estimated 2 million people per year. Bacteria and fungus are two main etiological agents that cause corneal ulcers. Although antibiotics and antifungals are commonly used to treat corneal infections, a clear trend with increasing resistance to these antimicrobials is emerging at rapid pace. Extensive research has been carried out to determine alternative therapeutic interventions, and antimicrobial peptides (AMPs) are increasingly recognized for their clinical potential in treating infections. Small molecules targeted against virulence factors of the pathogens and natural compounds are also explored to meet the challenges and growing demand for therapeutic agents. Here we review the potential of AMPs, small molecules, and natural compounds as alternative therapeutic interventions for the treatment of corneal infections to combat antimicrobial resistance. Additionally, we have also discussed about the different formats of drug delivery systems for optimal administration of drugs to treat microbial keratitis.
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Affiliation(s)
- Praveen Kumar Jadi
- Prof, Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Prerana Sharma
- Prof, Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
- Department of Animal Sciences, University of Hyderabad, Hyderabad, India
| | - Bharathi Bhogapurapu
- Prof, Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Sanhita Roy
- Prof, Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
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Parikh KS, Omiadze R, Josyula A, Shi R, Anders NM, He P, Yazdi Y, McDonnell PJ, Ensign LM, Hanes J. Ultra-thin, high strength, antibiotic-eluting sutures for prevention of ophthalmic infection. Bioeng Transl Med 2021; 6:e10204. [PMID: 34027091 PMCID: PMC8126818 DOI: 10.1002/btm2.10204] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 11/17/2022] Open
Abstract
Sutures are applied almost universally at the site of trauma or surgery, making them an ideal platform to modulate the local, postoperative biological response, and improve surgical outcomes. To date, the only globally marketed drug-eluting sutures are coated with triclosan for antibacterial application in general surgery. Loading drug directly into the suture rather than coating the surface offers the potential to provide drug delivery functionality to microsurgical sutures and achieve sustained drug delivery without increasing suture thickness. However, conventional methods for drug incorporation directly into the suture adversely affect breaking strength. Thus, there are no market offerings for drug-eluting sutures, drug-coated, or otherwise, in ophthalmology, where very thin sutures are required. Sutures themselves help facilitate bacterial infection, and antibiotic eye drops are commonly prescribed to prevent infection after ocular surgeries. An antibiotic-eluting suture may prevent bacterial colonization of sutures and preclude patient compliance issues with eye drops. We report twisting of hundreds of individual drug-loaded, electrospun nanofibers into a single, ultra-thin, multifilament suture capable of meeting both size and strength requirements for microsurgical ocular procedures. Nanofiber-based polycaprolactone sutures demonstrated no loss in strength with loading of 8% levofloxacin, unlike monofilament sutures which lost more than 50% strength. Moreover, nanofiber-based sutures retained strength with loading of a broad range of drugs, provided antibiotic delivery for 30 days in rat eyes, and prevented ocular infection in a rat model of bacterial keratitis.
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Affiliation(s)
- Kunal S. Parikh
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of OphthalmologyThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Center for Bioengineering Innovation & DesignJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Revaz Omiadze
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of OphthalmologyThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Aditya Josyula
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Richard Shi
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Nicole M. Anders
- Department of OncologySidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Ping He
- Department of OncologySidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Youseph Yazdi
- Center for Bioengineering Innovation & DesignJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Peter J. McDonnell
- Department of OphthalmologyThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Laura M. Ensign
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of OphthalmologyThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of OncologySidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Justin Hanes
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of OphthalmologyThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of OncologySidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
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Tsvetanova A, Powell RM, Tsvetanov KA, Smith KM, Gould DJ. Melting corneal ulcers (keratomalacia) in dogs: A 5-year clinical and microbiological study (2014-2018). Vet Ophthalmol 2021; 24:265-278. [PMID: 33794048 DOI: 10.1111/vop.12885] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To identify bacterial microorganisms associated with canine keratomalacia, review their antimicrobial sensitivity, and evaluate clinical outcomes compared to results of microbial culture. METHODS Retrospective analysis of clinical records of dogs diagnosed with a melting corneal ulcer presented to a referral hospital in Hertfordshire, UK between 2014 and 2018. RESULTS One hundred and ten melting corneal ulcers were sampled in 106 dogs. The most common pure bacterial isolate was Pseudomonas aeruginosa (n = 26) followed by β-hemolytic Streptococcus (n = 12). Melting corneal ulcers that cultured coagulase-positive Staphylococcus, coliform bacteria, Pasteurella multocida, Enterococcus, and Streptococcus viridans presented in smaller numbers and were analyzed together (n = 16). Multiple cultures were identified in nine cases (n = 9). Forty-seven cultures yielded no bacterial growth (n = 47). The susceptibility to fluoroquinolones remained high with the exception of β-hemolytic Streptococci. There was no significant difference in the ulcer severity at presentation in regard to the cultured bacteria. Overall, 63 eyes (57%) received surgical grafting in addition to medical treatment. In 14 cases (13%), the progression of corneal melting despite medical ± surgical treatment resulted in enucleation. Fifty-seven percent (8/14) of the enucleated eyes cultured pure Pseudomonas aeruginosa isolates. In contrast, all β-hemolytic Streptococcus-associated ulcers healed. CONCLUSIONS The most common bacterial species associated with canine keratomalacia were Pseudomonas aeruginosa and β-hemolytic Streptococcus. Because of the variation in antibacterial sensitivity between these two species, bacterial culture and sensitivity testing should be performed in all dogs presenting with keratomalacia. Melting corneal ulcers associated with pure Pseudomonas infection were significantly more likely to result in globe loss than melting corneal ulcers associated with other cultures.
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Affiliation(s)
- Agata Tsvetanova
- Davies Veterinary Specialists, Manor Farm Business Park, Hertfordshire, UK
| | | | - Kamen A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Kerry M Smith
- Davies Veterinary Specialists, Manor Farm Business Park, Hertfordshire, UK
| | - David J Gould
- Davies Veterinary Specialists, Manor Farm Business Park, Hertfordshire, UK
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15
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Gutiérrez-Abejón E, Herrera-Gómez F, Ayestarán-Martínez IJ, Álvarez FJ. Trend in the use of topical ocular anti-infectives in a region of Spain between 2015 and 2019: a population-based registry study. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2020; 33:453-458. [PMID: 33103400 PMCID: PMC7712348 DOI: 10.37201/req/096.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study presents the use and trends of use of topical ocular anti-infectives into a European population in the current decade (2015 to 2019) with an analysis of concomitant use with other ocular drugs, considering distribution by age and gender. METHODS A population-based registry study was carried out to assess the ocular anti-infectives use from 2015 to 2019. All dispensations of these medicines at pharmacies in the largest region of Spain, Castile and León, was accessed. The number of packages dispensed, the percentage of the population under treatment, diagnosis, and the concomitant use with other ocular medicines was observed. For all analyses, the population distribution by age and gender was considered. RESULTS An average of 198,000 packages of topical ocular anti-infectives were dispensed annually to 5.38% of the population, and more commonly for women than for men (5.83% vs. 4.91%). Children and the elderly used more these medicines. Tobramycin, alone or in combination, accounted for more than 68% of the total consumption (135,000 packages per year), and was the most widely used anti-infective in almost all identified diagnoses. Conjunctivitis (50.12%), and stye (11.51%) were the most frequent diagnoses. The consumption of ocular anti-infectives increased by 8.23% from 2015 to 2019, and more among men than in women. CONCLUSIONS Our findings show that the most used topical ocular anti-infective was tobramycin, in accordance with the clinical practice guidelines recommendations. However, ocular infections are sometimes treated empirically, especially conjunctivitis.
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Affiliation(s)
- E Gutiérrez-Abejón
- Eduardo Gutiérrez-Abejón, Pharmacological Big Data Laboratory, Faculty of Medicine, University of Valladolid, Valladolid, Spain.
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16
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Morgan-Warren PJ, Morarji JB. Trends in licence approvals for ophthalmic medicines in the United Kingdom. Eye (Lond) 2020; 34:1856-1865. [PMID: 31900439 PMCID: PMC7608198 DOI: 10.1038/s41433-019-0758-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 11/09/2022] Open
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17
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Mamah CC, Anyalebechi OC, Onwubiko SN, Okoloagu MN, Maduka-Okafor FC, Ebede SO, Umeh RE. Conjunctival bacterial flora and their antibiotic sensitivity among patients scheduled for cataract surgery in a tertiary hospital in south-east Nigeria. Graefes Arch Clin Exp Ophthalmol 2020; 259:443-448. [PMID: 32936360 DOI: 10.1007/s00417-020-04926-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To determine the pre-operative conjunctival bacteria flora and their antibiotic susceptibility among patients scheduled for cataract surgery. METHODS A descriptive, cross-sectional, hospital-based study design was adopted. It involved 104 consecutive, consented patients scheduled for cataract surgery at the University of Nigeria Teaching Hospital Enugu, from June to September 2017. The participants' socio-demographic characteristics, medical, and social history were obtained through interviewer-administered questionnaire. Conjunctival swab was obtained from the inferior fornix of the eye scheduled for cataract surgery using sterile swab stick and transported to medical laboratory for analysis. Susceptibility tests were carried out on the representatives of different groups of available antibiotics. Data was analyzed using the SPSS version 23. RESULT The participants were mainly females (64.4%), married, and farmers, with at least primary school education and a mean age of 64 ± 2SD years. The conjunctival swab bacteria isolation rate was 36.5%. Gram-positive bacteria accounted for 73.7% of the total isolates. Coagulase-negative Staphylococcus (34.2%) was the most frequently isolated bacteria. Gentamicin, ofloxacin, and polymycin B (76%) were the most efficacious antibiotics followed by moxifloxacin and tobramycin (68%) on all the isolates. Ofloxacin (82%) was the most sensitive to Gram positive while gentamicin (90%) was for Gram-negative bacteria. CONCLUSION In Enugu, the most common pre-operative conjunctival bacteria isolated were Coagulase-negative Staphylococcus with varied antibiotic sensitivity. Routine prophylaxis with gentamicin and ofloxacin is therefore advised to forestall the dreaded post-operative endophthalmitis.
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Affiliation(s)
- Cyril Chukwukama Mamah
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, PMB 01129, Nigeria
| | - Okey Charles Anyalebechi
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, PMB 01129, Nigeria
| | - Stella Ngozi Onwubiko
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, PMB 01129, Nigeria.
| | - Mary Nkeiruka Okoloagu
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, PMB 01129, Nigeria
| | - F C Maduka-Okafor
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, PMB 01129, Nigeria
| | - S O Ebede
- Department of Medical Microbiology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, PMB 01129, Nigeria
| | - R E Umeh
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, PMB 01129, Nigeria
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Mohammed AA, Ali MM, Zenebe MH. Bacterial etiology of ocular and periocular infections, antimicrobial susceptibility profile and associated factors among patients attending eye unit of Shashemene comprehensive specialized hospital, Shashemene, Ethiopia. BMC Ophthalmol 2020; 20:124. [PMID: 32228528 PMCID: PMC7106738 DOI: 10.1186/s12886-020-01398-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Eye infection is a public health problem in developing countries including Ethiopia. Bacteria are major causative agents of eye infections that can lead to loss of vision. The objective of this study was to determine bacterial etiology of ocular and periocular infections, antimicrobial susceptibility profile and associated factors among patients who visited the eye unit of Shashamane Comprehensive Specialized Hospital (SCSH). Method A hospital-based cross-sectional study was conducted at SCSH from September 1, 2018, to March 30, 2019. Specimens from the ocular and periocular areas were collected from a total of 332 patients who visited the eye unit. Specimens were inoculated on blood agar, chocolate agar, MacConkey agar, and mannitol salt agar. Isolated bacteria were identified by a series of biochemical tests using the standard bacteriological method. Antimicrobial susceptibility test was performed according to the Clinical and Laboratory Standard Institute by disk diffusion method. Factors that could be associated with ocular and periocular infection were collected by using structured questionnaire. Data analysis was done using SPSS version 22.0 software package. A P value less than 0.05 was considered statistically significant. Result Out of the total 332 study participants with ocular and periocular infections, 198(60%) were culture positive. The proportion of Gram-positive and Gram-negative bacteria were 135(68.2%) and 63(31.8%) respectively. Among Gram-positive bacteria, Staphylococcus aureus were predominant. Among Gram-negative bacteria, Escherichia coli were predominant. Most S. aureus were resistant to penicillin. Conclusion Majority of ocular and periocular infections in this study were caused by bacteria; Gram-positive bacteria were responsible for most cases.
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Affiliation(s)
| | - Musa Mohammed Ali
- Hawassa University College of Medicine and Health Sciences department of Medical laboratory, Awassa, Ethiopia
| | - Mengistu Hailemariam Zenebe
- Hawassa University College of Medicine and Health Sciences department of Medical laboratory, Awassa, Ethiopia
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Zhang X, Cao X, Qi P. Therapeutic contact lenses for ophthalmic drug delivery: major challenges. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2020; 31:549-560. [PMID: 31902299 DOI: 10.1080/09205063.2020.1712175] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Xiuju Zhang
- Department of General Practice, Linyi People’s Hospital, Linyi, Shandong, China
| | - Xiuzhen Cao
- Department of Anus and Intestine Surgery, Taian Central Hospital, Taian, Shandong, China
| | - Ping Qi
- Department of General Practice, Linyi People’s Hospital, Linyi, Shandong, China
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20
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Classification of Obviously Asymmetric Palpebral Fissures and Correction Based on Double Eyelid Surgery of the Primary Type. J Craniofac Surg 2019; 31:404-407. [PMID: 31856137 DOI: 10.1097/scs.0000000000006088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bilateral palpebral fissures (PF) are rarely symmetrical. Palpebral plastic surgery is common in the Chinese population. This study aimed to assess the classification of obviously asymmetric palpebral fissures (OAPF). In addition, double eyelid surgery-based correction for the primary subtype was examined. Various clinical signs and etiologies were examined, and OAPF were classified into 3 subtypes: primary, secondary, and aging. For the secondary and aging subtypes, curative surgeries target the relevant underlying conditions. Patients with the primary subtype underwent corrective surgery based on double eyelid operation. After 8 to 12 months of follow-up, the corrective effects of different surgeries were evaluated in patients (n = 48) with primary OAPF. Satisfying look was obtained in all 48 cases, with smooth double eyelid lines and shapes, and no overt asymmetry between the 2 eyes. Thirteen patients developed hypophasis after levator plication, which was resolved within 1 month. Preoperative and postoperative PF were significantly different (1.48 ± 0.24 versus 0.19 ± 0.09 mm; P < 0.05). Overall, patients with OAPF can be classified into the primary, secondary, and aging subtypes. The 48 cases with the primary subtype showed a satisfying look after double eyelid surgery-based correction.
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21
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Topete A, Serro A, Saramago B. Dual drug delivery from intraocular lens material for prophylaxis of endophthalmitis in cataract surgery. Int J Pharm 2019; 558:43-52. [DOI: 10.1016/j.ijpharm.2018.12.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/14/2018] [Accepted: 12/07/2018] [Indexed: 12/28/2022]
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Asbell PA, Pandit RT, Sanfilippo CM. Antibiotic Resistance Rates by Geographic Region Among Ocular Pathogens Collected During the ARMOR Surveillance Study. Ophthalmol Ther 2018; 7:417-429. [PMID: 30094698 PMCID: PMC6258574 DOI: 10.1007/s40123-018-0141-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Indexed: 01/12/2023] Open
Abstract
Introduction The Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) study is an ongoing nationwide surveillance program that surveys in vitro antibiotic resistance rates and trends among ocular bacterial pathogens. We report resistance rates by geographic region for isolates collected from 2009 through 2016. Methods Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa isolates from ocular infections were collected at clinical centers across the US and categorized by geographic region based on state. Minimum inhibitory concentrations (MICs) for various antibiotics were determined at a central laboratory, and isolates were classified as susceptible or resistant based on established breakpoints. Geographic differences in methicillin resistance among staphylococci were evaluated by χ2 test with multiple comparisons, whereas geographic differences in mean percentage antibiotic resistance were evaluated by one-way analyses of variance and Tukey’s test. Results Overall, 4829 isolates (Midwest, 1886; West, 1167; Northeast, 1143; South, 633) were evaluated. Across all regions, azithromycin resistance was high among S. aureus (49.4–67.8%), CoNS (61.0–62.8%), and S. pneumoniae (22.3–48.7%), whereas fluoroquinolone resistance ranged from 26.1% to 47.8% among S. aureus and CoNS. Across all regions, all staphylococci were susceptible to vancomycin; besifloxacin MICs were similar to those of vancomycin. Geographic differences were observed for overall mean resistance among S. aureus, S. pneumoniae, and P. aeruginosa isolates (p ≤ 0.005); no regional differences were found among CoNS and H. influenzae isolates. Methicillin resistance in particular was higher among S. aureus isolates from the South and CoNS isolates from the Midwest (p ≤ 0.006). Conclusion This analysis of bacterial isolates from the ARMOR study demonstrated geographic variation in resistance rates among ocular isolates, with greater in vitro resistance apparent in the South and Midwest for some organisms. These data may inform clinicians in selecting appropriate treatment options for ocular infections. Funding Bausch & Lomb, Inc.
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Affiliation(s)
- Penny A Asbell
- Cornea Service and Refractive Surgery Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rahul T Pandit
- Houston Methodist Eye Associates, Blanton Eye Institute, Houston, TX, USA
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Abstract
Water polo is a team sport that combines swimming with overhead throwing and wrestling. This places water polo players at risk for a unique group of illnesses and injuries. In addition to the medical problems and injuries seen in competitive swimmers, water polo players are at risk for a variety of traumatic injuries, including concussions, eye injuries, tympanic membrane perforation, fractures, dislocations, and lacerations. Repetitive overhead throwing also places these athletes at risk for related injuries, such as shoulder problems, including rotator cuff strain and impingement, and elbow problems, such as ulnar collateral ligament injuries, posteromedial impingement, and osteochondritis dissecans of the radial capitellum. This article serves as an overview of these illnesses and injuries, as well as how the aquatic environment affects pathogenesis, treatment, and return to play.
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Affiliation(s)
- Jennifer D Stromberg
- Carolina Family Practice and Sports Medicine, Clinical Associate, Duke Community and Family Medicine, Cary, NC
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Grzybowski A, Told R, Sacu S, Bandello F, Moisseiev E, Loewenstein A, Schmidt-Erfurth U. 2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations. Ophthalmologica 2018; 239:181-193. [PMID: 29393226 DOI: 10.1159/000486145] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/05/2017] [Indexed: 01/24/2023]
Abstract
Intravitreal injections (IVI) have become the most common intraocular procedure worldwide with increasing numbers every year. The article presents the most up-to-date review on IVI epidemiology and techniques. Unfortunately, important issues related to pre-, peri- and postinjection management lack randomized clinical trials for a final conclusion. Also, a great diversity of approaches exists worldwide. Therefore, expert consensus recommendations on IVI techniques are provided.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Reinhard Told
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Francesco Bandello
- Department of Ophthalmology, Vita-Salute University, San Raffaele Hospital, Milan, Italy
| | - Elad Moisseiev
- Department of Ophthalmology, Sackler Faculty of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- Department of Ophthalmology, Sackler Faculty of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Sackler Faculty of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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Bauer D, Alt M, Dirks M, Buch A, Heilingloh CS, Dittmer U, Giebel B, Görgens A, Palapys V, Kasper M, Eis-Hübinger AM, Sodeik B, Heiligenhaus A, Roggendorf M, Krawczyk A. A Therapeutic Antiviral Antibody Inhibits the Anterograde Directed Neuron-to-Cell Spread of Herpes Simplex Virus and Protects against Ocular Disease. Front Microbiol 2017; 8:2115. [PMID: 29163407 PMCID: PMC5671610 DOI: 10.3389/fmicb.2017.02115] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/17/2017] [Indexed: 12/17/2022] Open
Abstract
Herpes simplex virus (HSV) is a leading cause of blindness and viral encephalitis in the developed world. Upon reactivation from sensory neurons, HSV returns via axonal transport to peripheral tissues where it causes, e.g., severe, potentially blinding ocular diseases. In the present study we investigated whether the HSV-1/2 glycoprotein B-specific antibody mAb 2c or its humanized counterpart mAb hu2c can protect from ocular disease in a mouse model of HSV-1-induced acute retinal necrosis (ARN). In this model the viral spread from the initially infected to the contralateral eye resembles the routes taken in humans upon HSV reactivation. Systemic antibody treatment prior or early after infection effectively protected the mice from the development of ARN. These observations suggest that the antibody potently neutralized the infection and inhibited the viral transmission, since there was almost no virus detectable in the contralateral eyes and trigeminal ganglia of antibody treated mice. Besides of neutralizing free virus or limiting the infection via activating the complement or cellular effector functions, blocking of the anterograde directed neuron-to-cell spread of HSV represents a viable mode of action how mAb 2c protected the mice from ARN. We proved this hypothesis using a microfluidic chamber system. Neurons and epithelial cells were cultured in two separate compartments where the neurons sent axons via connecting microgrooves to the epithelial cells. Neurons were infected with a reporter HSV-1 strain expressing mCherry, and the co-culture was treated with neutralizing antibodies. In contrast to commercial polyclonal human HSV-neutralizing immunoglobulins, mAb 2c effectively blocked the anterograde directed neuron-to-cell transmission of the virus. Our data suggest that the humanized HSV-1/2-gB antibody protects mice from ocular disease by blocking the neuronal spread of HSV. Therefore, mAb hu2c may become a potent novel therapeutic option for severe ocular HSV infections.
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Affiliation(s)
- Dirk Bauer
- Department of Ophthalmology, Ophtha Lab, St. Franziskus-Hospital, Münster, Germany
| | - Mira Alt
- Institute of Virology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Miriam Dirks
- Institute of Virology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Anna Buch
- Institute of Virology, Hannover Medical School, Hannover, Germany
| | | | - Ulf Dittmer
- Institute of Virology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Bernd Giebel
- Institute for Transfusion Medicine, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - André Görgens
- Institute for Transfusion Medicine, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Vivien Palapys
- Institute of Virology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Maren Kasper
- Department of Ophthalmology, Ophtha Lab, St. Franziskus-Hospital, Münster, Germany
| | | | - Beate Sodeik
- Institute of Virology, Hannover Medical School, Hannover, Germany
| | - Arnd Heiligenhaus
- Department of Ophthalmology, Ophtha Lab, St. Franziskus-Hospital, Münster, Germany.,Department of Ophthalmology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Roggendorf
- Institute of Virology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Adalbert Krawczyk
- Institute of Virology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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Abstract
The eye is a highly complex, yet readily accessible organ within the human body. As such, the eye is an appealing candidate target for a vast array of drug therapies. Despite advances in ocular drug therapy research, the focus on pediatric ocular drug delivery continues to be highly underrepresented due to the limited number of degenerative ocular diseases with childhood onset. In this review, we explore more deeply the reasons underlying the disparity between ocular therapies available for children and for adults by highlighting diseases that most commonly afflict children (with focus on the anterior eye) and existing prognoses, recent developments in ocular drug delivery systems and nanomedicines for children, and barriers to use for pediatric patients.
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Affiliation(s)
- Natasha D. Sheybani
- Department of Biomedical Engineering, Virginia Commonwealth
University, Richmond, VA23284, United States
| | - Hu Yang
- Department of Chemical & Life Science Engineering, Virginia
Commonwealth University, Richmond, VA 23219, United States
- Department of Pharmaceutics, Virginia Commonwealth University,
Richmond, VA 23298, United States
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
23298, United States
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Başaran E. Ocular Application of Dirithromycin Incorporated Polymeric Nanoparticles: an In Vitro Evaluation. Turk J Pharm Sci 2017; 14:191-200. [PMID: 32454613 DOI: 10.4274/tjps.69855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/27/2017] [Indexed: 01/06/2023]
Abstract
Objectives Ocular drug delivery is a difficult challenge especially with topical intillation which results in rapid drainage and non-productive drug absorption. For the improvement of the pre-corneal retention time and enhancing the corneal permeability, colloidal drug delivery systems play an important role in enhancement of the ocular bioavailability. In this study, dirithromycin incorporated Kollidon® SR-based polymeric nanoparticles, an antibacterial agent, were formulated for the efficient treatment of severe ocular bacterial infections. Materials and Methods In this study, dirithromycin was incorporated into the Kollidon® SR-based nanoparticles by spray drying method. In vitro characteristic properties were evaluated in detail during the storage period of three months at three different conditions. Results The results of in vitro analyses revealed that characteristic properties of the particles were remained unchanged during the storage period of three months. Conclusion Kollidon® SR-based polymeric nanoparticles are good candidates for drug delivery systems in the treatment of severe ocular bacterial infections with dirithromycin.
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Affiliation(s)
- Ebru Başaran
- Anadolu University, Faculty of Pharmacy, Department of Pharmaceutical Technology, Eskişehir, Turkey
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Szilágyi BÁ, Gyarmati B, Horvát G, Laki Á, Budai-Szűcs M, Csányi E, Sandri G, Bonferoni MC, Szilágyi A. The effect of thiol content on the gelation and mucoadhesion of thiolated poly(aspartic acid). POLYM INT 2017. [DOI: 10.1002/pi.5411] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Barnabás Áron Szilágyi
- Soft Matters Group, Department of Physical Chemistry and Materials Science; Budapest University of Technology and Economics; Budapest Hungary
| | - Benjámin Gyarmati
- Soft Matters Group, Department of Physical Chemistry and Materials Science; Budapest University of Technology and Economics; Budapest Hungary
| | - Gabriella Horvát
- Institute of Pharmaceutical Technology and Regulatory Affairs; University of Szeged; Szeged Hungary
| | - Ádám Laki
- Soft Matters Group, Department of Physical Chemistry and Materials Science; Budapest University of Technology and Economics; Budapest Hungary
| | - Mária Budai-Szűcs
- Institute of Pharmaceutical Technology and Regulatory Affairs; University of Szeged; Szeged Hungary
| | - Erzsébet Csányi
- Institute of Pharmaceutical Technology and Regulatory Affairs; University of Szeged; Szeged Hungary
| | | | | | - András Szilágyi
- Soft Matters Group, Department of Physical Chemistry and Materials Science; Budapest University of Technology and Economics; Budapest Hungary
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Miller D. Update on the Epidemiology and Antibiotic Resistance of Ocular Infections. Middle East Afr J Ophthalmol 2017; 24:30-42. [PMID: 28546690 PMCID: PMC5433126 DOI: 10.4103/meajo.meajo_276_16] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE: The purpose of this review is to provide an update on the epidemiology and current antibiotic-resistant threats in ophthalmology. METHODS: Trends in frequency and antibiotic-nonsusceptible profiles during an 11 year-period (2005–2015) were evaluated and compared with the 5-year Antibiotic Resistance Monitoring in Ocular Microorganism (ARMOR) study. RESULTS: Trends in the current review confirmed the continued high rates of fluoroquinolone nonsusceptbility circulating among ocular methicillin-susceptible Staphylococcus aureus, methicillin-susceptible Staphylococcus epidermidis, methicillin-resistant S. aureus, and methicillin-resistant S. epidermidis isolates as well as the detection of uncommon, but emerging resistance (<5%) for Streptococcus pneumoniae, Streptococcus viridans group, Haemophilus influenzae, and Pseudomonas aeruginosa. We documented significant differences in empirical fluoroquinolone and aminoglycoside coverage for the top three ocular pathogens (coagulase-negative staphylococci, S. aureus, and P. aeruginosa) in general and for corneal isolates between the Miami and the ARMOR studies. Collectively, the coverage for Miami was 74% versus 65.9% for ARMOR (P < 0.0001, 5.3674–10.8042) for ciprofloxacin and 95.9% versus 84.2% for aminoglycosides (gentamicin/tobramycin) (P < 0.0001, 9.9925–13.3974). Monotherapy coverage for ciprofloxacin and levofloxacin for the most recent 5 years (2011–2015) was 76.6% and 77.1%, respectively. Combination therapy with a fluoroquinolone and vancomycin and/or vancomycin and an aminoglycoside provided coverage for 99% and 98% of the isolates, respectively. CONCLUSION: The etiology of ocular pathogens is patient, source, and geography specific. The true incidence and/or prevalence are unknown. Fluoroquinolone monotherapy as standard therapy for common ocular infections needs to be reassessed. Ophthalmologists must become proactive and join the crusade to develop practical and prudent strategies for the administration of topical antibiotics.
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Affiliation(s)
- Darlene Miller
- Research Associate Professor, Department of Ophthalmology, Department of Microbiology and Immunology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
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Kashiwabuchi F, Parikh KS, Omiadze R, Zhang S, Luo L, Patel HV, Xu Q, Ensign LM, Mao HQ, Hanes J, McDonnell PJ. Development of Absorbable, Antibiotic-Eluting Sutures for Ophthalmic Surgery. Transl Vis Sci Technol 2017; 6:1. [PMID: 28083445 PMCID: PMC5225995 DOI: 10.1167/tvst.6.1.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 10/23/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose To develop and evaluate an antibiotic-eluting suture for ophthalmic surgery. Methods Wet electrospinning was used to manufacture sutures composed of poly(L-lactide), polyethylene glycol (PEG), and levofloxacin. Size, morphology, and mechanical strength were evaluated via scanning electron microscopy and tensile strength, respectively. In vitro drug release was quantified using high performance liquid chromatography. In vitro suture activity against Staphylococcus epidermidis was investigated through bacterial inhibition studies. Biocompatibility was determined via histological analysis of tissue sections surrounding sutures implanted into Sprague-Dawley rat corneas. Results Sutures manufactured via wet electrospinning were 45.1 ± 7.7 μm in diameter and 0.099 ± 0.007 newtons (N) in breaking strength. The antibiotic release profile demonstrated a burst followed by sustained release for greater than 60 days. Increasing PEG in the polymer formulation, from 1% to 4% by weight, improved drug release without negatively affecting tensile strength. Sutures maintained a bacterial zone of inhibition for at least 1 week in vitro and elicited an in vivo tissue reaction comparable to a nylon suture. Conclusions There is a need for local, postoperative delivery of antibiotics following ophthalmic procedures. Wet electrospinning provides a suitable platform for the development of sutures that meet size requirements for ophthalmic surgery and are capable of sustained drug release; however, tensile strength must be improved prior to clinical use. Translational Relevance No antibiotic-eluting suture exists for ophthalmic surgery. A biocompatible, high strength suture capable of sustained antibiotic release could prevent ocular infection and preclude compliance issues with topical eye drops.
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Affiliation(s)
- Fabiana Kashiwabuchi
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kunal S Parikh
- Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Revaz Omiadze
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shuming Zhang
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD 21218, USA ; Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA ; Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD, USA
| | - Lixia Luo
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Himatkumar V Patel
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Qingguo Xu
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura M Ensign
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Hai-Quan Mao
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD 21218, USA ; Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA ; Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD, USA
| | - Justin Hanes
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA ; Departments of Environmental Health Sciences, Oncology, Neurosurgery, and Pharmacology & Molecular Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter J McDonnell
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Khodaee M, Edelman GT, Spittler J, Wilber R, Krabak BJ, Solomon D, Riewald S, Kendig A, Borgelt LM, Riederer M, Puzovic V, Rodeo S. Medical Care for Swimmers. SPORTS MEDICINE-OPEN 2016; 2:27. [PMID: 27512647 PMCID: PMC4960281 DOI: 10.1186/s40798-016-0051-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/07/2016] [Indexed: 12/25/2022]
Abstract
Swimming is one of the most popular sports worldwide. Competitive swimming is one of the most watched sports during the Olympic Games. Swimming has unique medical challenges as a result of a variety of environmental and chemical exposures. Musculoskeletal overuse injuries, overtraining, respiratory problems, and dermatologic conditions are among the most common problems swimmers encounter. Although not unique to swimming, overtraining is a serious condition which can have significant negative impact on swimmers' health and performance. This review article is an attempt to discuss various issues that a medical team should consider when caring for swimmers.
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Affiliation(s)
- Morteza Khodaee
- Department of Family Medicine, University of Colorado School of Medicine, Denver, CO USA
| | - George T Edelman
- Edelman Spine & Orthopaedic Physical Therapy, Dover, DE USA ; Department of Physical Therapy, University of Delaware, Newark, DE USA
| | - Jack Spittler
- Department of Family Medicine, University of Colorado School of Medicine, Denver, CO USA
| | - Randall Wilber
- United State Olympic Committee, Colorado Springs, CO USA
| | - Brian J Krabak
- Rehabilitation, Orthopedics and Sports Medicine, University of Washington and Seattle Children's Sports Medicine, Seattle, WA USA
| | | | - Scott Riewald
- Winter Sports, United States Olympic Committee, Colorado Springs, CO USA
| | - Alicia Kendig
- United State Olympic Committee, Colorado Springs, CO USA
| | - Laura M Borgelt
- Department of Clinical Pharmacy and Family Medicine, University of Colorado Skaggs School of Pharmacy and School of Medicine, Aurora, CO USA
| | - Mark Riederer
- Department of Pediatrics and Orthopaedic Surgery, University of Michigan, Ann Arbor, MI USA
| | - Vladimir Puzovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Scott Rodeo
- Sports Medicine and Shoulder Service, Orthopaedic Surgery, The Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY USA ; Tissue Engineering, Regeneration, and Repair Program, The Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY USA
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Paradiso P, Serro AP, Saramago B, Colaço R, Chauhan A. Controlled Release of Antibiotics From Vitamin E–Loaded Silicone-Hydrogel Contact Lenses. J Pharm Sci 2016; 105:1164-72. [DOI: 10.1016/s0022-3549(15)00193-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 11/12/2015] [Accepted: 11/20/2015] [Indexed: 11/24/2022]
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Jug Došler A, Petročnik P, Mivšek AP, Zakšek T, Skubic M. Neonatal Prophylaxis: Prevention of Vitamin K Deficiency Haemorrhage and Neonatal Ophthalmia. Zdr Varst 2015; 54:184-93. [PMID: 27646726 PMCID: PMC4820155 DOI: 10.1515/sjph-2015-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/03/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction The aim of the study was to explore two aspects of neonatal prophylaxis: the application of the vitamin K injection to the newborns and the prophylaxis against chlamydial and gonococcal eye infections, comparing Slovenian and Croatian practices. Methods A causal non-experimental method of quantitative empirical approach was used. The data was collected by means of predesigned questionnaires. The questionnaires were sent to 14 Slovenian and 32 Croatian birth hospitals. The data was analysed with descriptive statistics and the Kullback test. Results Vitamin K is applied to all newborns in 9 (out of 14) Slovene and 22 (out of 32) Croatian birth hospitals that returned the questionnaire. The prophylaxis against chlamydial gonococcal eye infections is applied to all newborns in 9 Slovene and 16 Croatian birth hospitals that offered answers to the questionnaire. The majority of Slovene and Croatian birth hospitals perform these procedures in the first hour after birth. The majority of Slovene birth hospitals still apply vitamin K in the gluteal muscle, whereas the majority of Croatian birth hospitals usually use the thigh as an injection site. In Slovenia, 1 % Targesin is used for the prophylaxis against chlamydial and gonococcal eye infections, whereas in Croatia the prevailing medicine is Erythromycin. Conclusions The possibility of oral vitamin K application should be offered to parents, and pain management in practice should be discussed. The form of written informed consent could be offered to parents. Health professionals should provide intimacy and exclude routine procedures in the first couple of hours after birth. However, more research is needed as delayed administration might be related to lower efficacy and, as a consequence of that, the safety of newborns is questionable.
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Affiliation(s)
- Anita Jug Došler
- University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 1, 1000 Ljubljana, Slovenia
| | - Petra Petročnik
- University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 1, 1000 Ljubljana, Slovenia
| | - Ana Polona Mivšek
- University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 1, 1000 Ljubljana, Slovenia
| | - Teja Zakšek
- University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 1, 1000 Ljubljana, Slovenia
| | - Metka Skubic
- University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 1, 1000 Ljubljana, Slovenia
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Bremond-Gignac D, Nezzar H, Bianchi PE, Messaoud R, Lazreg S, Voinea L, Speeg-Schatz C, Hartani D, Kaercher T, Kocyla-Karczmarewicz B, Murta J, Delval L, Renault D, Chiambaretta F. Efficacy and safety of azithromycin 1.5% eye drops in paediatric population with purulent bacterial conjunctivitis. Br J Ophthalmol 2014; 98:739-45. [PMID: 24526744 PMCID: PMC4033170 DOI: 10.1136/bjophthalmol-2013-303888] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective To determine the efficacy and safety of azithromycin 1.5% eye drops in a paediatric population with purulent bacterial conjunctivitis. Patients and methods This was a multicentre, international, randomised, investigator-masked study in 286 children with purulent discharge and bulbar conjunctival injection. Patients received either azithromycin 1.5% eye drops (twice daily for 3 days) or tobramycin 0.3% eye drops (every 2 h for 2 days, then four times daily for 5 days). Clinical signs were evaluated on day (D) 0, 3 and 7, and cultures on D0 and D7. The primary variable was the clinical cure (absence of bulbar conjunctival injection and discharge) on D3 in the worse eye for patients with positive cultures on D0. Results 286 patients (mean age 3.2 years; range 1 day–17 years) were included; 203 had positive cultures on D0. Azithromycin was superior to tobramycin in clinical cure rate on D3 (47.1% vs 28.7%, p=0.013) and was non-inferior to tobramycin on D7 (89.2% vs 78.2%, respectively). Azithromycin treatment eradicated causative pathogens, including resistant species, with a similar resolution rate to tobramycin (89.8% vs 87.2%, respectively). These results were confirmed in a subgroup of patients younger than 24 months old. Conclusions Azithromycin 1.5% eye drops provided a more rapid clinical cure than tobramycin 0.3% eye drops in the treatment of purulent bacterial conjunctivitis in children, with a more convenient twice-a-day dosing regimen.
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Affiliation(s)
- Dominique Bremond-Gignac
- Service d'Ophtalmologie, Centre Saint Victor, CHU d'Amiens, Université Picardie Jules Verne, Amiens, France INSERM UMRS968, Institut de la Vision, Université Paris 6, Paris, France
| | - Hachemi Nezzar
- Service d'Ophtalmologie, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France IGCNC-EA7282-UMR6284 ISIT, UFR Médecine, Université d'Auvergne, Clermont Université, Clermont-Ferrand, France
| | | | - Riadh Messaoud
- Service d'Ophtalmologie, Hôpital Régional de la Madhia, CHU Tahar Sfar de Mahdia, Mahdia, Tunisie
| | | | - Liliana Voinea
- Ophthalmology Department, University Emergency Hospital, Bucharest, Romania
| | | | | | | | | | - Joaquim Murta
- Faculty of Medicine, Department of Ophthalmology, Centro Hospitalar Universitário Coimbra, University of Coimbra, Coimbra, Portugal
| | | | | | - Frédéric Chiambaretta
- Service d'Ophtalmologie, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France EA 7281 R2D2, Laboratoire de Biochimie Médicale, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France
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Mencucci R, Pellegrini-Giampietro DE, Paladini I, Favuzza E, Menchini U, Scartabelli T. Azithromycin: assessment of intrinsic cytotoxic effects on corneal epithelial cell cultures. Clin Ophthalmol 2013; 7:965-71. [PMID: 23737659 PMCID: PMC3667995 DOI: 10.2147/opth.s43934] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the cytotoxic effects of preservative-free azithromycin on corneal epithelial cells in vivo with those of preservative-free netilmicin and levofloxacin, and the preservative benzalkonium chloride (BAK). Methods Rabbit corneal epithelial cells in vitro were incubated for 15 minutes or 6 hours with commercially available ophthalmic preservative-free netilmicin 0.3%, levofloxacin 0.3%, or azithromycin 1.5% preparations or different concentrations of unpreserved azithromycin and different concentrations of BAK. Qualitative analysis was undertaken using phase-contrast optics to examine the morphological aspects of cell cultures and quantitative analysis was undertaken by measuring the release of the cytoplasmic enzyme lactate dehydrogenase into the medium immediately and 24 hours after exposure to drugs. Finally, we observed the wound-healing rate of mechanically injured corneal epithelial cells exposed to each antibiotic ophthalmic preparation for 48 hours. Results Our results show that both the commercially available unpreserved mono-dose preparation of azithromycin and ophthalmic preparations of azithromycin up to a concentration of 1.5% were virtually devoid of harmful effects under our experimental conditions. This was not significantly different from the results obtained for the other antibiotic preparations (P > 0.05) tested, but was unlike the results obtained for BAK. Azithromycin 1.5% also showed good recovery properties after a mechanical wound test. Conclusion Under our experimental conditions, unpreserved azithromycin 1.5% showed a much lower toxicity than BAK and did not interfere with the wound-healing process.
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Affiliation(s)
- Rita Mencucci
- Department of Specialized Surgical Science - Eye Clinic, University of Florence, Florence, Italy
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Keating GM, Lyseng-Williamson KA, Garnock-Jones KP. Azithromycin 1.5 % ophthalmic solution: a guide to its use in purulent bacterial conjunctivitis and trachomatous conjunctivitis. DRUGS & THERAPY PERSPECTIVES 2013. [DOI: 10.1007/s40267-013-0022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Garnock-Jones KP. Azithromycin 1.5% ophthalmic solution: in purulent bacterial or trachomatous conjunctivitis. Drugs 2012; 72:361-73. [PMID: 22316352 DOI: 10.2165/11208580-000000000-00000] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The second-generation macrolide azithromycin is available as a 1.5% ophthalmic solution for use in the treatment of bacterial or trachomatous conjunctivitis. This article reviews the pharmacological properties of azithromycin 1.5% ophthalmic solution and its clinical efficacy and tolerability in patients with purulent bacterial conjunctivitis or trachomatous conjunctivitis caused by Chlamydia trachomatis. Azithromycin 1.5% ophthalmic solution had good in vitro activity against Haemophilus influenzae and C. trachomatis, and achieved good concentrations in tear samples from healthy volunteers. Azithromycin 1.5% ophthalmic solution for 3 days (1 drop twice daily) was noninferior to tobramycin 0.3% ophthalmic solution for 7 days (1 drop every 2 hours) in paediatric and adult patients with purulent bacterial conjunctivitis, with regard to clinical cure and bacteriological resolution on day 9, in a randomized, investigator-masked, multicentre study. In children with trachomatous inflammation, 3-day treatment with azithromycin 1.5% ophthalmic solution was noninferior to a single dose of azithromycin oral suspension, with regard to clinical cure rate in the worst eye at 60 days, in a randomized, double-masked, multicentre study. Azithromycin 1.5% ophthalmic solution was well tolerated in patients with bacterial or trachomatous conjunctivitis. Most events were of mild to moderate severity.
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