In the world of ophthalmology, eye drops are essential drugs to treat a wide range of diseases, but the use of antibiotics such as fluoroquinolones in eye drops is raising significant concerns related to growing bacterial resistance and side effects, both local and systemic.
I fluoroquinolones are broad-spectrum antibiotics which act by inhibiting bacterial enzymes essential for DNA duplication, a property that makes them effective against a wide range of pathogenic bacteria. However, overuse or inappropriate use can contribute to bacterial resistance, a phenomenon that makes bacteria less sensitive to antibiotics.
These antibiotics are used in eye drops to treat eye infections, including the conjunctivitis. Their ability to penetrate ocular tissues makes them particularly useful in ophthalmology.
Fluoroquinolones are preferred for their efficacy against certain bacterial strains resistant to other antibiotics but, with increasing use, bacterial resistance to these drugs is also on the rise.
The use of fluoroquinolones in eye drops requires physicians to balance the therapeutic benefits against the risks of resistance and side effects. It is essential to consider alternatives and adopt a personalised approach for each patient.
Antibiotic resistance
Fluoroquinolones are not immune to the problem of antibiotic resistance. The overuse of these drugs has led to the development of resistant bacterial strains, complicating the treatment of eye infections.
Resistance to fluoroquinolones develops when bacteria undergo mutations that make them less sensitive to these antibiotics, reducing their effectiveness, requiring higher dosages or the use of alternative drugs.
One of the main factors contributing to resistance is theinappropriate use of fluoroquinolones, such as taking them without a prescription or not completing a course of treatment. These behaviours favour the selection of resistant bacteria.
Addressing these challenges requires an approach that includes patient education, correct prescribing by doctors and the development of new antibiotics.
The impact of antibiotic resistance means that when resistant bacteria infect the eye, treatment becomes more difficult and often requires more aggressive or prolonged therapies.
In some cases, resistance can lead to relapsing or chronic infectionsincreasing the risk of serious complications. In addition, the need to use alternative antibiotics may lead to more side effects.
To mitigate the impact of resistance, it is crucial to implement treatment protocols that provide for the targeted use of antibiotics and promote infection prevention.
Side effects of eye drops
The use of eye drops containing fluoroquinolones is not without risk and side effects may vary from mild irritation to more severe reactions requiring medical attention.
Ocular side effects of fluoroquinolone eye drops often include redness, burning or itching. These symptoms are generally temporary, but in some cases may indicate a more serious allergic reaction.
In rare cases, prolonged use of fluoroquinolones can lead to keratitis or corneal erosions. These conditions require immediate medical attention to prevent permanent damage to vision.
To minimise risks, it is important to follow the doctor's instructions and monitor any unusual symptoms that may occur during treatment.
Systemic side effects
Fluoroquinolones can cause systemic side effects if absorbed in significant amounts. These may include allergic reactions, gastrointestinal disorders and, in rare cases, neurological disorders.
Systemic effects are more common when fluoroquinolones are taken orally, but are not excluded with the use of eye drops, especially if they are used excessively or inappropriately.
Guidelines and tips for use
Guidelines:
- Always consult your doctor: Never start treatment without a doctor's prescription.
- Follow instructionsUse the drug exactly as prescribed, without altering the dosage or duration of treatment.
- Monitoring symptoms: Report any suspected side effects to your doctor immediately.
Essential advice:
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- Complete the course of antibiotics, even if the symptoms improve.
- Avoiding self-prescription: Do not use antibiotic eye drops without an appropriate medical diagnosis.
- Always wash your handsi before applying eye drops to prevent additional infections.
On this topic see also
- Keratitis and resistance to fluoroquinolones - Oculista Italiano
- Adverse ocular reactions associated with fluoroquinolones: implications for intracameral use - Oculista Italiano
- Hinkle DM. Re-assessing Evidence for Adverse Ocular Reactions Associated with Fluoroquinolones: Implications for Intracameral Use. Ocul Immunol Inflamm. 2022 Jan 2;30(1):208-209.
- Scott DAR, Mansell C, McKelvie J. Bacteria identified on corneal scrapes demonstrate increasing resistance to fluoroquinolones in New Zealand. Clin Exp Ophthalmol. 2022 Apr;50(3):352-354. doi: 10.1111/ceo.14061. Epub 2022 Mar 1. Erratum in: Clin Exp Ophthalmol. 2022 May;50(4):468. doi: 10.1111/ceo.14094. PMID: 35195336.