December 23, 2020
3 min reading
The Re-SOLVE Antibiotic Resistance initiative aims to introduce practitioners to the global health problems associated with antibiotic resistance.
In the fight against antibiotic resistance, ophthalmologists play an important role and are invited to join the Re-SOLVE Antibiotic Resistance initiative launched by Santen.
“We perform an average of 4.5 million cataract surgeries a year, and up to 97% of us use postoperative antibiotics. This results in several million days of annual exposure to beetle antibiotics, which can then develop resistance. ” Ali Mearza, MBBS, FRCOphthsaid an ophthalmic surgeon and director of ophthalmological consultants in London.
In a campaign launched in October, Santen has teamed up with ophthalmologists to fight antibiotic resistance to raise awareness of this global health priority and promote actions for the sustainable and effective use of antibiotics.
“Resistance develops naturally because organisms develop and mutate. However, the overuse and abuse of antibiotics has accelerated this problem, ”Mearza said.
According to the European Center for Disease Prevention and Control, microbial-resistant infections cause at least 50,000 deaths each year in Europe and the United States, and hundreds of thousands die in other parts of the world. If the way antibiotics are prescribed does not change radically, that number could increase to 10 million a year by 2050.
“There are actions we can take especially as ophthalmologists,” Mearza said.
First, stop abusing antibiotics for viral infections such as viral conjunctivitis.
“It may seem obvious, but this is not an unusual practice,” he said.
Second, stop using them for a long time unnecessarily, and third, stop using them prophylactically.
“Along with cataract surgery, we give prophylactic antibiotics all the time, which is a huge contribution to the increased resistance of bacteria. In addition, we narrow the use of antibiotics during prophylaxis, which is also a way of causing resistance, ”said Mearza.
Better approach to prophylaxis
Antibiotics are used in cataract surgery to prevent infection, primarily endophthalmitis. However, several studies have shown that the best prophylaxis against endophthalmitis is a combination of povidone-iodine instilled into the conjunctival sac prior to surgery and cefuroxime or moxifloxacin administered intrachamber during surgery.
“Swedish experience and the ESCRS study have shown that intraventricular antibiotic prophylaxis has superior efficacy over postoperative antibiotics, especially against gram-negative bacteria,” Mearza said.
Intracameral cefuroxime has become the standard for preventing infection during cataract surgery in the UK and other European countries. In Sweden, where it was first accepted as a routine practice, postoperative antibiotics are not used with it. According to Mearza, if they are not completely eliminated, postoperative antibiotics should be given for a maximum of 1 week.
“It is common practice to give antibiotics for 4 weeks along with steroids. We should switch our practice to 1 week four times a day, and then stop without narrowing down. “This is a sufficient dose for known pathogens to be killed in a prophylactic dose, and not in a therapeutic dose,” he said.
Call to action
The Re-SOLVE Antibiotic Resistance initiative aims to make ophthalmologists aware of the important role they play in alleviating the global health problems associated with antibiotic resistance, encouraging them to grow out of old habits.
“Giving antibiotics for 3 or 4 weeks is a standard pattern of practice without much explanation, but change is not easy. We need the support of a large study that shows that one week is equally protected, and we don’t have it yet. However, a lot of my colleagues in the UK have been working for a week and it is not decreasing, ”said Mearza.
Ophthalmologists are globally praying to “join the revolution” and play their part in managing antibiotics through actions that promote the sustainable and effective use of antibiotics.
“In terms of action, we are trying to promote the message that there is good evidence to support the use of povidone-iodine and intra-chamber antibiotics. This is the key thing for the prevention of endophthalmitis, and not a prolonged postoperative course. Another message is that short-term therapy is more than adequate postoperatively. There are cheap and effective options, such as 0.5% chloramphenicol. The final message is to work closely with microbiologists to develop guidelines for the most appropriate use of antibiotics in the conditions we are treating, in line with the changes due to antibiotic resistance, ”Mearza said.
New and more powerful antibiotics may be developed in the future, but research is currently at a standstill, and few funds in development have reached phase 3 of the study.
“The golden age of antibiotics, which discovered penicillin, cephalosporins and quinolones, is over. There is not so much planned at the moment, and we should try to make the most of the antibiotics we have, making them last as long as possible, “Mearza said.
For more information:
But Mearza,, MBBS,, FRCOphth,, you can get them from ophthalmic consultants in London, 55 New Cavendish St., Marylebone, London W1G 9TF; e-mail: [email protected]; Website: www.oclvision.com.