Abstract
The treatment of eye infections is very different than treating other body infections that require systemic anti-infectives. Endophthalmitis, keratitis, conjunctivitis, and other ocular infections are treated with direct injection and with topical drops directly to the infection site. There are no anti-infective susceptibility standards to interpret treatment success, but the systemic standards can be used to guide ocular therapy if the concentration of anti-infective in the ocular tissue is assumed to be higher than the concentration in the blood serum. This Perspective describes: (1) eye infections, (2) diagnostics of eye infections, (3) anti-infective treatment of eye infections, (4) anti-infective resistance of ocular pathogens, and (5) alternative anti-infective delivery and therapy. The data, based on years of clinical and laboratory research, support the premise that ocular infections are less problematic if etiologic agents are laboratory-diagnosed and if prompt, potent, anti-infective therapy is applied. Anti-infective susceptibility should be monitored to assure continued therapeutic success and the possibility of new-found resistance. New delivery systems and therapies may be helpful to better treat future ocular infections.
Highlights
The treatment of eye infections is completely different than other parts of the body.Eye infections in general are not treated systemically but are treated with anti-infectives using topical drops and direct injection, which provide very high effective levels of antiinfectives into the ocular tissue [1]
Previous studies have indicated that ciprofloxacin, ofloxacin, moxifloxacin, and besifloxacin may be effective against bacterial keratitis isolates on the basis of concentrations achieved in human corneal tissue [3,4,5]
Systemic clinical microbiology laboratories could use the CLSI standards to guide effective ocular antibiotic treatment with the recognition of an important assumption that “Anti-infective concentrations achieved in the ocular tissues by the topical or direct injection are higher than the anti-infective concentrations achieved in the ocular tissues through oral or intravenous administration”
Summary
The treatment of eye infections is completely different than other parts of the body. Systemic clinical microbiology laboratories could use the CLSI standards to guide effective ocular antibiotic treatment with the recognition of an important assumption that “Anti-infective concentrations achieved in the ocular tissues by the topical or direct injection are higher than the anti-infective concentrations achieved in the ocular tissues through oral or intravenous administration”. This Perspective will describe (1) eye infections, (2) diagnostics of eye infections, (3) antiinfective treatment of ocular infections, (4) anti-infective resistance of ocular pathogens, and (5) alternative anti-infective delivery and therapy. The Perspective is based on the experiences of a certified independent clinical ophthalmic microbiology laboratory. (http: //eyemicrobiology.upmc.com) (accessed on 25 January 2022)
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