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About 60 percent of patients nationwide are prescribed antibiotic eye drops, even though antibiotics are rarely necessary to treat this common eye infection. Of the patients filling antibiotic prescriptions, 20 percent filled prescriptions for antibiotic-steroid eye drops that can prolong or worsen the infection.
The study by the University of Michigan Kellogg Eye Center is consistent with a nationwide trend of antibiotic misuse for common viral and mild bacterial conditions. It's a trend that increases costs to patients and the health care system and may promote antibiotic resistance.
Using data from a large managed care network in the United States, researchers identified the number of patients who filled antibiotic eye drop prescriptions for acute conjunctivitis. They then evaluated the characteristics of patients who filled prescriptions compared to those who did not.
Pinkeye affects 6 million people in the United States each year and is a major driver of emergency room visits for ocular problems. There are three types: viral, bacterial and allergic conjunctivitis. Most cases are caused by viral infections or allergies and do not respond to antibiotics. Artificial tears and warm compresses may help keep the eye comfortable while viral conjunctivitis runs its course.
Cause unknown. It is a challenge to differentiate bacterial conjunctivitis from the viral and allergic forms. All three types may have overlapping features, such as a red eye, thin discharge, irritation and sensitivity to light. Health care providers may be unsure of the cause and prescribe antibiotics "just in case." Several rapid, point-of-care tests for adenovirus are in development that could save an estimated $400 million in health care spending in the U.S. alone.
School policies. Children with pinkeye may not be able to attend school or day care unless they are being treated, presumably to reduce transmission. In an accompanying editorial, such policies were called "highly inconvenient for patients and parents" and "devoid of evidence," considering the more rapidly spreading viral conjunctivitis is unlikely to be influenced by a topical antibiotic.
"Educating patients about acute conjunctivitis' often benign, self-limited course may help to dispel misconceptions about the condition and reduce reflexive demands for immediate antibiotic use," says Stein, who is also a member of the U-M Institute for Healthcare Policy and Innovation.
The American Academy of Ophthalmology has issued guidance to the medical community on treatment for pinkeye. The Academy tells health care providers to avoid prescribing antibiotics for viral conditions and to delay immediate treatment when the cause of conjunctivitis is unknown.
If you have a persistent eye infection and do not have access to treatment then The Online Clinic can prescribe a range of antibiotic drops and ointments online for next day delivery. Please complete the short medical questionnaire to get access to the treatments online.
Most often, eye infections follow a temporary course, resolving without treatment. However, some infections may need a medicine to resolve and prevent further problems. Compresses, made with a clean cloth soaked in cool or warm water and wrung out, may be placed on your closed eyelid to relieve discomfort and help remove any discharge. Similarly, eye drops known as artificial tears can be used to relieve symptoms of infections. Anti-infective medicines may also be needed and will be selected according to the microorganism your eye is infected with. Thus, antibiotics (e.g. chloramphenicol, ciloxan, fucithalmic, and genticin) may be used for bacterial infections, while antivirals (e.g. acyclovir) are used for viral infections. Sometimes corticosteroids are needed to reduce the inflammation. Anti-infectives can be in the form of eye drops, ointments or orally-taken medicines.
In most cases, you won't need antibiotic eye drops. Since conjunctivitis is usually viral, antibiotics won't help. They may even cause harm by reducing their effectiveness in the future or causing a medicine reaction. Instead, the virus needs time to run its course. This typically takes around 2 to 3 weeks.
If the irritation is allergic conjunctivitis, your health care provider may prescribe one of many different types of eye drops for people with allergies. These may include medicines that help control allergic reactions, such as antihistamines and mast cell stabilizers. Or your provider may recommend medicines to help control inflammation, such as decongestants, steroids and anti-inflammatory drops.
Ophthalmic products specifically indicated for allergic conjunctivitis most often contain an antihistamine combined with a vasoconstrictor. They include Naphcon-A, Opcon-A, and Visine-A. The products are safe and effective in patients over the age of 6 years, in a dose of 1 to 2 drops in the affected eye(s) up to four times daily. Patients should stop using the product and see a physician if they experience eye pain, changes in vision, or continued redness or irritation of the eye, or if the condition persists for more than 72 hours. The drops can also cause rebound conjunctivitis if used too often or for too long a period.1,8 They should not be used by patients with heart disease, hypertension, difficulty in urination due to an enlarged prostate, or narrow-angle glaucoma, unless directed to do so by a physician.
Dry eye is common, and many OTC products are available to treat it. They include drops and gels for daytime use and small tubes of ointment for nighttime use. Examples include Refresh, GenTeal, and TheraTears (daytime) and Refresh PM and Refresh Lacri-Lube (nighttime).
Infections of the eye or surrounding skin should always be seen by an eye care professional. This includes pinkeye, styes, infections of the eyelids, and other suspected infections. Physicians may need to prescribe antibiotics or other safe and effective products.
OTC antihistamine, decongestant and vasoconstrictor eye drops can reduce the redness and irritation of viral pink eye. All three work to shrink the size of the blood vessels along the surface of the eye.
A true bacterial infection, however, typically does not self resolve and will require antibiotics.In addition to others, your eye doctor may prescribe eye drops containing one of the following antibiotics:
More severe cases of allergic conjunctivitis are generally treated with a steroid eye drop. They may also benefit from stronger prescription antihistamines and mast cell stabilizers, usually in the form of eye drops.
It is important to use the right antibiotic for the specific bacterium infecting the eye, so a person should not reuse old antibiotics. In most cases, a doctor will recommend antibiotics in the form of eye drops or eye cream.
Corneal abrasions result from cutting, scratching, or abrading the thin, protective, clear coat of the exposed anterior portion of the ocular epithelium. These injuries cause pain, tearing, photophobia, foreign body sensation, and a gritty feeling. Symptoms can be worsened by exposure to light, blinking, and rubbing the injured surface against the inside of the eyelid. Visualizing the cornea under cobalt-blue filtered light after the application of fluorescein can confirm the diagnosis. Most corneal abrasions heal in 24 to 72 hours and rarely progress to corneal erosion or infection. Although eye patching traditionally has been recommended in the treatment of corneal abrasions, multiple well-designed studies show that patching does not help and may hinder healing. Topical mydriatics also are not beneficial. Initial treatment should be symptomatic, consisting of foreign body removal and analgesia with topical non-steroidal anti-inflammatory drugs or oral analgesics; topical antibiotics also may be used. Corneal abrasions can be avoided through the use of protective eyewear.
Although eye patches, topical antibiotics, and mydriatic agents traditionally have been used in patients with corneal abrasions, treatment recommendations recently have evolved. Current recommendations stress the use of topical or oral analgesics and topical antibiotics (Table 1) . Most corneal abrasions heal with this approach.
If antibiotics are used, ointment (e.g., baci-tracin [AK-Tracin], erythromycin, gentamycin [Garamycin]) is more lubricating than drops and is considered first-line treatment. In patients who wear contact lenses, an anti-pseudomonal antibiotic (e.g., ciprofloxacin [Ciloxan], gentamycin, ofloxacin [Ocuflox]) should be used, and contact lens use should be discontinued. Clinical trial data are lacking, but it is recommended that contact lenses be avoided until the abrasion is healed and the antibiotic course completed.13
Method: Retrospective, descriptive, non-comparative study. Medical and biological data were extracted from the patients' file treated with strengthened antibiotic eye drops at Angers University Hospital between January 2015 and June 2016. The main elements noted were the bacteria involved and their susceptibility to antibiotics. Patients' visual acuity at the start and end of treatment was compared.
Results: Forty-eight patients were included. Almost one bacterium was identified in 31 patients, totalling 43 pathogens of 24 different species. The most frequently found microorganisms were Gram-positive cocci (55.8%), including Staphylococcus Aureus (14.0%) and Epidermidis (14.0%). All Gram-negative bacilli amounted to 30.2% of the identified bacteria, including 9.3% of Pseudomonas aeruginosa. None of the Gram-positive cocci were resistant to vancomycin and all Gram-negative bacilli were susceptible to ceftazidime and amikacin. Following treatment with at least one of the three antibiotic eye drops produced by our pharmacy (amikacin at 50mg/mL, ceftazidime at 50mg/mL and vancomycin at 25mg/mL), patients' visual acuity was significantly improved (P=0.043). 041b061a72